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| last=Joudi |init=M, |last2=Fathi M, Hiradfar |init2=M | firstlast3=Hiradfar | coauthorsinit3=M | title=Incidence of asymptomatic meatal stenosis in children following neonatal circumcision | journal=J Pediatr Urol | volume=7 | issue=5 | pages=526-528 | url=https://www.sciencedirect.com/science/article/abs/pii/S1477513110004341 | quote= | pubmedID=20851685 | pubmedCID= | DOI=10.1016/j.jpurol.2010.08.005 | date=Oct 2011-10 | accessdate=2020-02-01}}</ref> Meatal stenosis is a relatively common acquired condition occurring in 910%-1020% 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 [[Foreskin#Protective_functions| foreskin protection]], 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 uncircumcised [[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 | last=Van Howe | firstinit=R.S.RS | coauthorsauthor-link=Robert S. Van Howe | title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting | journal=Clin Pediatr (Phila) | volume=45 | issue=1 | pages=49-54 | url=https://www.academia.edu/6992015/Incidence_of_Meatal_Stenosis_following_Neonatal_Circumcision_in_a_Primary_Care_Setting | quote= | pubmedID=16429216 | pubmedCID=https://doi.org/10.1177/000992280604500108 | DOI= | date=Jan2006-Feb 200601 | accessdate=2020-01-09 |note=Jan-Feb 2006

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.

* Difficult-to-aim (upward deflected), high-velocity (long distance) stream of [[urine]]

If the physician desires to calibrate the meatus, Litvak et al . report that the meatus in children younger than 1 year will accept a lubricated 5F feeding tube. They also report that, in children aged 1-6 years, an 8F feeding tube should pass without difficulty.<ref>{{REFjournal | last=Litvak |init=AS, |last2=Morris |init2=JA, McRoberts JW | firstlast3=McRoberts | coauthorsinit3=JW | title=Normal size of the urethral meatus in boys | journal=J Urol | volume=115 | issue=6 | pages=736-737 | url= | quote= | pubmedID=940216 | pubmedCID= | DOI=10.1016/s0022-5347(17)59355-6 | date=Jun 1976-06 | accessdate=2020-02-01

In a child who is circumcised, persistent exposure of the meatus to [[urine ]] and mechanical trauma from rubbing against a wet diaper results in ammoniacal dermatitis, <ref name="brenneman1921">{{REFjournal |last=Brennemann |init=J |author-link= |last2= |init2= |author2-link= |url=http://www.cirp.org/library/complications/brennemann1/ |title=The ulcerated meatus in the circumcised child |journal=Am J Dis Child |date=1921 |volume=21 |issue= |pages=38-47 |accessdate=2024-02-04}}</ref> loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.

** A 10-year retrospective series at [http://www.childrenshospital.org/ Boston Children's Hospital ] included 41 patients with a median age of 10.6 years. Eighty-five percent of the patients were aged 8-13 years. The disease process was found to involve the prepuce, the glans, and, sometimes, the [[urethra]]. The most common referral diagnoses included phimosis (52%), balanitis (13%), and buried penis (10%). In 46% of the patients, circumcision was curative. Twenty-seven percent (11 patients) had meatal involvement that was treated by meatotomy and meatoplasty, and 22% required extensive plastic procedures of the penis, including buccal mucosal grafts.<ref>{{REFjournal | last=Gargollo |init=PC, |last2=Kozakewich |init2=HP, |last3=Bauer SB, et al. | firstinit3=SB | coauthorsetal=yes | title=Balanitis xerotica obliterans in boys | journal=J Urol | volume=174 | issue=4 Pt 1 | pages=1409-1412 | url= | quote= | pubmedID=16145451 | pubmedCID= | DOI=10.1097/01.ju.0000173126.63094.b3 | date=Oct 2005-10 | accessdate=2020-01-01

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 | last=Brown |init=MR, |last2=Cartwright |init2=PC, Snow BW | firstlast3=Snow | coauthorsinit3=BW | title=Common office problems in pediatric urology and gynecology | journal=Pediatr Clin North Am | volume=44 | issue=5 | pages=1091-1115 | url= | quote= | pubmedID=9326954 | pubmedCID= | DOI=10.1016/s0031-3955(05)70549-6 | date=Oct 1997-10 | accessdate=2020-02-01

* 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.

* In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and & Smith (2000) found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only 1 patient had recurrent meatal stenosis).<ref>{{REFjournal | last=Smith |init=C, Smith DP | firstlast2=Smith | coauthorsinit2=DP | title=Office pediatric urologic procedures from a parental perspective | journal=Urology | volume=55 | issue=2 | pages=272-276 | url= | quote= | pubmedID=10688093 | pubmedCID= | DOI=10.1016/s0090-4295(99)00571-3 | date=Feb 2000-02 | accessdate=2020-02-01

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