Changes

Genital disorders are commonly encountered in the office of the primary care physician.<ref>{{REFjournal

|last=Joudi

|last2=Fathi

|last3=Hiradfar

|title=Incidence of asymptomatic meatal stenosis in children following neonatal circumcision

|journal=J Pediatr Urol

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, 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.<ref>{{REFjournal

|last=Van Howe

|author-link=Robert S. Van Howe

|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting

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

|last2=Morris

|last3=McRoberts

|title=Normal size of the urethral meatus in boys

|journal=J Urol

** 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

|last2=Kozakewich

|last3=Bauer

|etal=yes

|title=Balanitis xerotica obliterans in boys

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

|last2=Cartwright

|last3=Snow

|title=Common office problems in pediatric urology and gynecology

|journal=Pediatr Clin North Am

* In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith & 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

|last2=Smith

|title=Office pediatric urologic procedures from a parental perspective

|journal=Urology