Meatal stenosis

Urethral meatal stenosis
Classification and external resources
ICD-9	598.9
DiseasesDB	13562
MeSH	D014525

Urethral meatal stenosis or urethral stricture is a narrowing (stenosis) of the opening of the urethra at the external meatus ( /miːˈeɪtəs/), thus constricting the opening through which urine leaves the body from the urinary bladder.

Causes, incidence, and risk factors

Studies have indicated that male circumcision contributes to the development of urethral stricture. Among circumcised males, reported incidence figures include 0%,^[1] 0.01%,^[2] 0.55%,^[3] 0.9%,^[4] 2.8%,^[5] 7.29%,^[6] 9-10%,^[7] and 11%.^[8] In Van Howe's study, all cases of meatal stenosis were among circumcised boys.^[6] When the meatus is not covered by the foreskin, it can rub against urine soaked diapers resulting in inflammation and mechanical trauma.^[7] Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.^[6][7][9]

In non-circumcised males, meatal stenosis can occur where phimosis or lichen sclerosus is present.^[10][11]

In females, this condition is a congenital abnormality which can cause urinary tract infections and bed-wetting.

Symptoms

• Abnormal strength and direction of urinary stream
• Visible narrow opening at the meatus in boys
• Irritation, scarring or swelling of the meatus in boys
• Discomfort with urination (dysuria and frequency)
• Incontinence (day or night)
• Bleeding (hematuria) at end of urination
• Urinary tract infections - increased susceptibility due to stricture

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.^[7] Recently, home-dilation has been shown to be a successful treatment for most boys.^[12]

Prognosis

Most people can expect normal urination after treatment.^[7]

Prevention

"In a recently circumcised male infant, try to maintain a clean, dry diaper and avoid any exposure of the newly circumcised penis to irritants."^[13]

Meir and Livne suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]",^[14] while Jayanthi recommends the use of a modified Snodgrass hypospadias repair.^[15] Viville states that "prevention is based essentially upon more caution in the use of indwelling urethral catheters."^[16]

References

1. ^ Sörensen SM, Sörensen MR (1988). "Circumcision with the Plastibell device. A long-term follow-up". Int Urol Nephrol 20 (2): 159–66. PMID 3384610. 
2. ^ Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE (July 2006). "Trends in paediatric circumcision and its complications in England between 1997 and 2003". Br J Surg 93 (7): 885–90. doi:10.1002/bjs.5369. PMID 16673355. 
3. ^ Simforoosh N, Tabibi A, Khalili SA, et al. (November 2010). "Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell". J Pediatr Urol. doi:10.1016/j.jpurol.2010.10.008. PMID 21115400. 
4. ^ Yegane, R.A.; A.R. Kheirollahi, N.A. Salehi, M. Bashashati, J.A. Khoshdel and M. Ahmadi (May 2006). "Late complications of circumcision in Iran". Pediatr Surg Int 22 (5): 442–445. doi:10.1007/s00383-006-1672-1. PMID 16649052. 
5. ^ Griffiths, D.M; Atwell JD, Freeman NV (1985). "A prospective survey of the indications and morbidity of circumcision in children". Eur Urol 11 (3): 184–7. PMID 4029234. 
6. ^ ^{a b c} Van Howe, R.S. (2006). "Incidence of meatal stenosis following neonatal circumcision in a primary care setting". Clin Pediatr (Phila) 45 (1): 49–54. doi:10.1177/000992280604500108. PMID 16429216. 
7. ^ ^{a b c d e} Angel, C.A. (June 12, 2006). "Meatal stenosis". eMedicine. http://www.emedicine.com/PED/topic2356.htm. Retrieved 2008-09-07. 
8. ^ Stenram A, Malmfors G, Okmian L (1986). "Circumcision for phimosis: a follow-up study". Scand. J. Urol. Nephrol. 20 (2): 89–92. doi:10.3109/00365598609040554. PMID 3749823. 
9. ^ Persad, R.; S. Sharma, J. McTavish, C. Imber and P.D. Mouriquand (January 1995). "Clinical presentation and pathophysiology of meatal stenosis following circumcision". British Journal of Urology 75 (1): 91–93. doi:10.1111/j.1464-410X.1995.tb07242.x. PMID 7850308. 
10. ^ Parkash, S.; S. Jeyakumar, K. Subramanyan and S. Chaudhuri (August 1973). "Human subpreputial collection: its nature and formation". The Journal of Urology 110 (2): 211–212. PMID 4722614. 
11. ^ Buechner, S.A. (September 2002). "Common skin disorders of the penis". BJU Int 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID 12175386. 
12. ^ Searles, J.M.; A.E. MacKinnon (March 2004). "Home-dilatation of the urethral meatus in boys". BJU Int 93 (4): 596–597. doi:10.1111/j.1464-410X.2003.04680.x. PMID 15008738. 
13. ^ "Meatal stenosis". Medline Plus. National Library of Medicine. August 17, 2006. http://www.nlm.nih.gov/medlineplus/ency/article/001599.htm. Retrieved 2008-09-07. 
14. ^ Meir, D.B.; P.M. Livne (June 2004). "Is prophylactic antimicrobial treatment necessary after hypospadias repair?". The Journal of Urology 171 (6 part 2): 2621–2622. doi:10.1097/01.ju.0000124007.55430.d3. PMID 15118434. 
15. ^ Jayanthi, V.R. (October 2003). "The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis". The Journal of Urology 170 (4 part 2): 1603–1605; discussion 1605. doi:10.1097/01.ju.0000085260.52825.73. PMID 14501672. 
16. ^ Viville, C.; J. Weltzer (1981). "[Iatrogenic stenosis of the male urethra. 50 cases (author's transl)] (French)". Journal d'urologie 87 (7): 413–418. PMID 7310161.