Meatal Stenosis Clinical Presentation
- Author: Carlos A Angel, MD; Chief Editor: Marc Cendron, MD more...
History
Patient history may include the following:
- Difficult-to-aim (upward deflected), high-velocity (long distance) stream of urine
- Pain upon initiation of micturition
- Need to stand back from toilet or sit during urination
- Burning at meatus
- Blood spots in underwear
- Urgent, frequent, and prolonged emptying of the bladder
Physical
Meatal stenosis can be suspected based on the presence of a small meatus during examination, particularly if, with lateral traction, the ventral edges of the meatus appear fused.
Observation of the child while voiding helps immensely in confirming the diagnosis of the disorder.
If the physician desires to calibrate the meatus, Litvak et al report that the meatus in children younger than 1 year will accept a lubricated 5F feeding tube. They also report that, in children aged 1-6 years, an 8F feeding tube should pass without difficulty.[3]
Causes
In a child who is circumcised, persistent exposure of the meatus to urine and mechanical trauma from rubbing against a wet diaper results in ammoniacal dermatitis, loss of meatal epithelium, and fusion of its ventral edges. This results in a pinpoint orifice at the tip of the glans.
Other causes of meatal stenosis include the following:
- Unsuccessful hypospadias repair
- Trauma
- Prolonged catheterization
- Balanitis xerotica obliterans
- Balanitis xerotica obliterans (BXO), which is an unusual condition that causes a whitish discoloration and dry appearance of the glans, can also cause meatal stenosis.
- A 10-year retrospective series at Boston Children's Hospital included 41 patients with a median age of 10.6 years. Eighty-five percent of the patients were aged 8-13 years. The disease process was found to involve the prepuce, the glans, and, sometimes, the urethra. The most common referral diagnoses included phimosis (52%), balanitis (13%), and buried penis (10%). In 46% of the patients, circumcision was curative. Twenty-seven percent (11 patients) had meatal involvement that was treated by meatotomy and meatoplasty, and 22% required extensive plastic procedures of the penis, including buccal mucosal grafts.[4]
- In children with BXO, meatal stenosis seems to be quite common.
- Although BXO is difficult to treat, meatotomy yields good results in patients with BXO.
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