Meatal stenosis
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Urethral meatal stenosis is a narrowing (stenosis) of the opening of the urethra at the external meatus, thus constricting the opening through which urine leaves the body from the urinary bladder.
Causes, incidence, and risk factors
Many authors have stated that meatal stenosis in males is caused by circumcision. It occurs in 0.9% [3]- 10% [4] of circumcised males and, according to Van Howe, is generally only found in circumcised males.[5] When the meatus is not covered by the foreskin, it can rub against urine soaked diapers resulting in inflammation and mechanical trauma. Eventually, the delicate epithelial lining of the outer urethra is lost, leaving only a pinpoint hole at the tip of the glans. Meatal stenosis may also be caused by damage to the frenular artery during circumcision. [6] [7] [8] Meatal stenosis may also be associated with phimosis in uncircumcised males.[9] It may also be caused by lichen sclerosus.[10]
In females, this condition is a congenital (present from birth) abnormality which can cause urinary tract infections and bed-wetting (enuresis).
Symptoms
- Abnormal strength and direction of urinary stream
- Visible narrow opening at the meatus in boys
- Discomfort with urination (dysuria and frequency)
- Incontinence (day or night)
- Bleeding (hematuria) at end of urination
- Urinary tract infections
Signs and tests
In boys, history and physical exam is adequate to make the diagnosis. In girls, VCUG (voiding cystourethrogram) is usually diagnostic. Other tests may include:
- Urine analysis
- Urine culture
- CBC, basic metabolic panel
- Renal and bladder ultrasound
Treatment
In females, meatal stenosis can usually be treated in the physician's office using local anesthesia to numb the area and dilating (widening) the urethral opening with special instruments.
In boys, it is treated by a second surgical procedure called meatotomy in which the meatus is crushed for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors. Recently, home-dilation has been shown to be a successful treatment for most boys. [11]
Prognosis
Most people can expect normal urination after treatment.
Complications
Persistent urinary problems including abnormal stream, painful urination, frequent urination, urinary incontinence, blood in the urine, and increased susceptibility to urinary tract infections can be complications.
Prevention
"In a recently circumcised male infant, try to maintain a clean, dry diaper and avoid any exposure of the newly circumcized penis to irrititants (sic)." [12]
Meir and Livne suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]", [13] while Jayanthi recommends the use of a modified Snodgrass hypospadias repair.[14] Viville states that "prevention is based essentially upon more caution in the use of indwelling urethral catheters."[15]