Urethral meatal stenosis or urethral stricture 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
Studies have indicated that male circumcision contributes to the development of urethral stricture, with risk estimates ranging from 0.9%[1] to 10%.[2] According to Van Howe, the disease is found primarily in boys who have been circumcised.[3] When the meatus is not covered by the foreskin, it can rub against urine soaked diapers resulting in inflammation and mechanical trauma.[2] Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.[2][3][4]
Meatal stenosis is associated with phimosis and lichen sclerosus in uncircumcised males.[5][6]
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
- 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:
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.citation needed Recently, home-dilation has been shown to be a successful treatment for most boys.[7]
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 irritants."[8]
Meir and Livne suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]",[9] while Jayanthi recommends the use of a modified Snodgrass hypospadias repair.[10] Viville states that "prevention is based essentially upon more caution in the use of indwelling urethral catheters."[11]
References
- ^ 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. PMID 16649052.
- ^ a b c Angel, C.A. (June 12, 2006). "Meatal stenosis". eMedicine. Retrieved on 2008-09-07.
- ^ a b Van Howe, R.S. (2006). "Incidence of meatal stenosis following neonatal circumcision in a primary care setting". Clin Pediatr (Phila) 45 (1): 49-54. PMID 16429216.
- ^ 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. PMID 7850308.
- ^ 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.
- ^ Buechner, S.A. (September 2002). "Common skin disorders of the penis". BJU Int 90 (5): 498-506. PMID 12175386.
- ^ Searles, J.M.; A.E. MacKinnon (March 2004). "Home-dilatation of the urethral meatus in boys". BJU Int 93 (4): 596-597. PMID 15008738.
- ^ "Meatal stenosis". Medline Plus. National Library of Medicine (August 17, 2006). Retrieved on 2008-09-07.
- ^ 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. PMID 15118434.
- ^ 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. PMID 14501672.
- ^ 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.
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