epispadias
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 is treatment is surgical.
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 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.
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.
The most effective treatment is surgery called meatotomy. The tissues that are causing the obstruction at the tip of 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.
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.
Though not recommended usually, meatal dilation is also a treatment option, in which urethral opening is gently and gradually stretched with specified dilation instrument. It can be complicated by meatus tear, and often this can lead to more scarring and recurrence of stenosis with more severe symptoms.
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.
The procedure takes anywhere from 15-30 minutes.
No, it is performed as day case procedure, under local or general anaesthesia. Patient can go home the same day
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.
Meatotomy is a safe procedure with very complication, the most common being bleeding which can usually be controlled by direct pressure application. Other complication can be infection, discomfort, swelling, redness, difficulty in urination and recurrence.
After surgery, if proper care is given and instructions are followed, meatal stenosis rarely comes back
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