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'''Meatal stenosis''' is a narrowing of the ''meatus'' (the opening of the [[urethra]]). Meatal stenosis is extremely rare in [[intact ]] boys with a protective [[foreskin]]. About twenty percent of [[circumcised ]] boys develop meatal stenosis. Meatal stenosis may be prevented by avoiding child [[circumcision]], which is a medically-unnecessary, non-therapeutic surgical [[amputation]] procedure.

}}</ref> Meatal stenosis is a relatively common acquired condition occurring in 10%-20% of males who are [[Circumcision| circumcised]]. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged [[urination]]. Surgical meatotomy is curative.

After [[circumcision]] and the loss of the protective [[Foreskin#Protective_functions| foreskinprotection]], a child who is not toilet-trained persistently exposes the [[meatus ]] to [[urine]], resulting in inflammation (ammoniacal dermatitis) and mechanical [[trauma ]] as the meatus rubs against a wet diaper (nappie). This causes the loss of the delicate epithelial lining of the distal [[urethra]]. This loss may result in adherence of the epithelial lining at the ventral side, leaving a pinpoint orifice at the tip of the glans. Because this condition is exceedingly rare in [[intact]] children, [[circumcision ]] is believed to be the most important causative factor of meatal stenosis.

Another hypothetical cause of this condition is ischemia due to damage to the frenular artery during [[circumcision]], resulting in poor blood supply to the meatus and subsequent stenosis. In a prospective study of circumcised boys, [[Robert S. Van Howe|Van Howe]] (2006) found meatal stenosis in 24 of 239 (7.29%) children older than 3 years, making meatal stenosis the most common complication of circumcision.<refname="vanhowe2006">{{REFjournal

Meatal stenosis affects 910%-1020% of males who are [[circumcised]] in infancy.

Morbidity is limited to the clinical symptoms and complications of surgical repair, including [[bleeding]], [[infection]], and recurrence.

Meatal stenosis has no racial predilection. The condition can occur in [[circumcised ]] males independent of ethnicity.

=== Sex Gender ===

Children who are not toilet-trained are more prone to develop meatal stenosis after [[circumcision ]] because of exposure of the meatus to ammonia from the [[urine]] in diapers. Most children who are toilet-trained can verbalize their difficulties during micturition to their caregivers.

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Brown et al. (1997) reported excellent results following 130 office meatotomies with only 2 recurrences of meatal stenosis and 1 patient with [[bleeding ]] requiring stitches. They also cited the cost-effectiveness of this treatment and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation, as their presence seemed to have a calming effect.<ref>{{REFjournal

* If the caregivers and the patient are cooperative, this procedure can be performed in the office of the physician using a topical eutectic mixture of local anesthetics ([[EMLA ]] cream) applied liberally over the entire glans and secured in place for at least one hour with an occlusive dressing.

Complications include [[bleeding ]] during or after meatotomy, infection, and recurrence. All of these complications are quite rare and respond readily to appropriate management.