MEATAL STENOSIS

MEATAL STENOSIS

Narrowing or blockage of the urethral opening (the opening at the tip of penis from where urine passes) is called meatal stenosis.

It can be congenital(present at birth) or may occur later in life. It can be caused by trauma/injury to the tissue around the opening which results in scarring and narrowing.

It is an uncommon condition and its treatment is surgical.

CAUSES

This condition usually occurs in circumcised males, Other causes can be injury to the tip of penis or Inflammation that results from a baby’s penis rubbing against a diaper or the baby’s own skin after circumcision. Long-term use of urinary catheters (tubes to drain urine) and Hypospadias surgery can also be a reason of meatal stenosis. The risk of meatal stenosis is also higher with Inflammatory skin conditions (including balanitis and BXO)

SYMPTOMS

The narrowed opening causes obstruction to urine flow and may results in following symptoms;

Sudden urges to urinate
Pain or burning during micturition
Increased frequency of urination Upward directed, messy or sprayed urinary stream
small, narrow, very fast urinary stream which is difficult to aim

problem with fully emptying the bladder
A drop of blood at the tip of the penis after urinating.

DIAGNOSIS

The diagnosis is established with history and physical examination. Your doctor may examine the child during urination to see the urinary stream, if it is sprayed and deflected, usually intervention is needed.

TREATMENT

The most effective treatment is surgery called meatotomy. The tissues that are causing the obstruction at the tip of the urethral opening are cut sharply to make the opening bigger. The cut ends are sometimes stitched with dissolvable sutures. An ointment is applied over the surgery site.

Meatal dilation is also considered a treatment option but should be seen with caution due to risks associated with this procedure.

FAQs

1. How long does it last if left untreated? Are there any problems if not operated?
Meatal stenosis will not go away on its own, if left untreated it can lead to multitude of problems like urinary tract infections, kidney problems, involuntary urination, or backflow of urine.
2. Is there any alternative to surgery?
Though not recommended usually, meatal dilation is also a treatment option, in which urethral opening is gently and gradually stretched with a specified dilation instrument. It can be complicated by meatus tears, and often this can lead to more scarring and recurrence of stenosis with more severe symptoms.

3. How can it be prevented?
Congenital meatal stenosis cannot be prevented. Choosing to leave the penis uncircumcised and leaving foreskin intact is another way to prevent this condition. Avoidance of irritation or injury to the penis after circumcision(rub by diaper, irritating detergents, wet or rough nappies) can help.
How long does the procedure take?
The procedure takes anywhere from 15-30 minutes.
4. Does it need a hospital overnight stay?
No, it is performed as a day case procedure, under local or general anaesthesia. Patient can go home the same day
5. What is the recovery time?
After surgery, pain killers are usually given to avoid discomfort and pain. Recovery usually takes 1-2 days, though wound healing is complete by 7-10 days. You may need to apply ointment over the surgical site for a couple of weeks to help wound healing.
6. Are there any complications of surgery?
Meatotomy is a safe procedure with many complications, the most common being bleeding which can usually be controlled by direct pressure application. Other complications can be infection, discomfort, swelling, redness, difficulty in urination and recurrence.
7. What are chances of success?
After surgery, if proper care is given and instructions are followed, meatal stenosis rarely comes back

Written by : Dr. Sobia Yasmeen