Meatal stenosis

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

The protection provided by the foreskin for the glans penis and meatus has been recognized since 1915. In the absence of the foreskin the meatus is exposed to mechanical and chemical irritation from ammoniacal diaper (nappy) that produces blister formation and ulceration of the urethral opening, which eventually gives rise to meatal stenosis (a narrowing of the opening).{{cite journal | vauthors = Frisch M, Simonsen J | title = Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013 | journal = The Surgeon | volume = 16 | issue = 2 | pages = 107–118 | date = April 2018 | pmid = 28017691 | pmc = | doi = 10.1016/j.surge.2016.11.002 | doi-access = free }} Published online ahead of print on 22 December 2016. Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.{{cite journal | vauthors = Van Howe RS | title = Incidence of meatal stenosis following neonatal circumcision in a primary care setting | journal = Clinical Pediatrics | volume = 45 | issue = 1 | pages = 49–54 | year = 2006 | pmid = 16429216 | doi = 10.1177/000992280604500108 }}

Frisch & Simonsen (2016) carried out a very large-scale study in Denmark, which compared the incidence of meatal stenosis in Muslim males (mostly circumcised) with the incidence of meatal stenosis in ethnic Danish males (mostly non-circumcised). The risk of meatal stenosis in circumcised males was found to be as much 3.7 times higher than in the non-circumcised males.

In males, history and physical exam is adequate to make the diagnosis. In females, VCUG (voiding cystourethrogram) is usually diagnostic. Other tests may include:{{cn|date=April 2021}}

• Urine analysis
• Urine culture
• CBC, basic metabolic panel
• Renal and bladder ultrasound

According to Frisch & Simonsen (2016), "the foreskin is protective against urinary stricture disease" (meatal stenosis). Frisch & Simonsen (2016) call for a "thorough reassessment of the burden of urethral troubles and other adverse outcomes after non-therapeutic circumcision of boys."

Meir & Livne (2004) suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]",{{cite journal | vauthors = Meir DB, Livne PM | title = Is prophylactic antimicrobial treatment necessary after hypospadias repair? | journal = The Journal of Urology | volume = 171 | issue = 6 Pt 2 | pages = 2621–2 | date = June 2004 | pmid = 15118434 | doi = 10.1097/01.ju.0000124007.55430.d3 }} while Jayanthi (2003) recommends the use of a modified Snodgrass hypospadias repair.{{cite journal | vauthors = Jayanthi VR | title = The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis | journal = The Journal of Urology | volume = 170 | issue = 4 Pt 2 | pages = 1603–5; discussion 1605 | date = October 2003 | pmid = 14501672 | doi = 10.1097/01.ju.0000085260.52825.73 }}

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.{{cn|date=April 2021}}

In males, it is treated by a second surgical procedure called meatotomy in which the meatus is crushed with a straight mosquito hemostat and then divided with fine-tipped scissors. Recently, home-dilatation has been shown to be a successful treatment for most boys.{{cite journal | vauthors = Searles JM, MacKinnon AE | title = Home-dilatation of the urethral meatus in boys | journal = BJU International | volume = 93 | issue = 4 | pages = 596–7 | date = March 2004 | pmid = 15008738 | doi = 10.1111/j.1464-410X.2003.04680.x | s2cid = 8817008 }}

Most people can expect normal urination after treatment.

Numerous studies over a long period of time clearly indicate that male circumcision contributes to the development of urethral stricture. Among circumcised males, reported incidence of meatal stricture varies. Griffiths et al. (1985) reported an incidence of 2.8 percent.{{cite journal | vauthors = Griffiths DM, Atwell JD, Freeman NV | title = A prospective survey of the indications and morbidity of circumcision in children | journal = European Urology | volume = 11 | issue = 3 | pages = 184–7 | year = 1985 | pmid = 4029234 | doi = 10.1159/000472487 }} Sörensen & Sörensen (1988) reported 0 percent.{{cite journal | vauthors = Sörensen SM, Sörensen MR | title = Circumcision with the Plastibell device. A long-term follow-up | journal = International Urology and Nephrology | volume = 20 | issue = 2 | pages = 159–66 | year = 1988 | pmid = 3384610 | doi = 10.1007/BF02550667 | s2cid = 29147788 }} Cathcart et al. (2006) reported an incidence of 0.55 percent.{{cite journal | vauthors = Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE | title = Trends in paediatric circumcision and its complications in England between 1997 and 2003 | journal = The British Journal of Surgery | volume = 93 | issue = 7 | pages = 885–90 | date = July 2006 | pmid = 16673355 | doi = 10.1002/bjs.5369 | s2cid = 42869269 | doi-access = free }} Yegane et al. (2006) reported an incidence of 0.9 percent.{{cite journal | vauthors = Yegane RA, Kheirollahi AR, Salehi NA, Bashashati M, Khoshdel JA, Ahmadi M | title = Late complications of circumcision in Iran | journal = Pediatric Surgery International | volume = 22 | issue = 5 | pages = 442–5 | date = May 2006 | pmid = 16649052 | doi = 10.1007/s00383-006-1672-1 | s2cid = 26365305 }} Van Howe (2006) reported an incidence of 7.29 percent. In Van Howe's study, all cases of meatal stenosis were among circumcised boys. Simforoosh et al. (2010) reported an incidence of 0.55 percent.{{cite journal | vauthors = Simforoosh N, Tabibi A, Khalili SA, Soltani MH, Afjehi A, Aalami F, Bodoohi H | title = Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: a large prospective study with long-term follow up using Plastibell | journal = Journal of Pediatric Urology | volume = 8 | issue = 3 | pages = 320–3 | date = June 2012 | pmid = 21115400 | doi = 10.1016/j.jpurol.2010.10.008 }} According to Emedicine (2016), the incidence of meatal stenosis runs from 9 to 20 percent.{{cite web |

author= Koenig JF | work = EMedicine | title=Meatal stenosis | url=http://emedicine.medscape.com/article/1016016-overview | date=22 September 2016 | access-date=21 August 2017}} Frisch & Simonsen (2016) placed the incidence at 5 to 20 percent of circumcised boys.

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{{Medical resources

| ICD10 =

| ICD9 = {{ICD9|598.9}}

| ICDO =

| OMIM =

| DiseasesDB = 13562

| MedlinePlus = 001599

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D014525

}}

{{Urinary tract disease}}

{{DEFAULTSORT:Meatal Stenosis}}

Category:Urethra disorders