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Meatal Stenosis

  • Author: Carlos A Angel, MD; Chief Editor: Marc Cendron, MD  more...
 
Updated: Sep 10, 2014
 

Background

Genital disorders are commonly encountered in the office of the primary care physician.[1] Meatal stenosis is a relatively common acquired condition occurring in 9-10% of males who are circumcised. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative.

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Pathophysiology

After circumcision, a child who is not toilet-trained persistently exposes the meatus to urine, resulting in inflammation (ammoniacal dermatitis) and mechanical trauma as the meatus rubs against a wet diaper. This causes the loss of the delicate epithelial lining of the distal urethra. This loss may result in adherence of the epithelial lining at the ventral side, leaving a pinpoint orifice at the tip of the glans. Because this condition is exceedingly rare in uncircumcised children, circumcision is believed to be the most important causative factor of meatal stenosis.

Another hypothetical cause is ischemia due to damage to the frenular artery during circumcision, resulting in poor blood supply to the meatus and subsequent stenosis. In a prospective study of circumcised boys, Van Howe found meatal stenosis in 24 of 239 (7.29%) children older than 3 years, making meatal stenosis the most common complication of circumcision.[2] As many as 1 in 5 boys who have undergone circumcision for balanitis xerotica obliterans (BXO; also referred to as lichen sclerosus) may require subsequent operative treatment of meatal pathology.[3]

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Epidemiology

Frequency

International

Meatal stenosis affects 9%-10% of males who are circumcised.

Mortality/Morbidity

Meatal stenosis carries no risk of mortality.

Morbidity is limited to the clinical symptoms and complications of surgical repair, including bleeding, infection, and recurrence.

Race

Meatal stenosis has no racial predilection. The condition can occur in circumcised males independent of ethnicity.

Sex

Meatal stenosis occurs only in males.

Age

Children who are not toilet-trained are more prone to develop meatal stenosis after circumcision because of exposure of the meatus to urine in diapers. Most children who are toilet-trained can verbalize their difficulties during micturition to their caregivers.

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Contributor Information and Disclosures
Author

Carlos A Angel, MD Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group

Carlos A Angel, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, New York Academy of Sciences, Society of Critical Care Medicine, Texas Pediatric Society, Children's Oncology Group, International Pediatric Endosurgery Group, International Children's Continence Society, British Association of Paediatric Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Harry P Koo, MD Chairman of Urology Division, Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, New Hampshire Medical Society, Society for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

Additional Contributors

Howard M Snyder, III, MD Professor, Department of Surgery, Division of Pediatric Urology, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia

Howard M Snyder, III, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, National Kidney Foundation

Disclosure: Nothing to disclose.

References
  1. Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol. 2011 Oct. 7(5):526-8. [Medline].

  2. Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). 2006 Jan-Feb. 45(1):49-54. [Medline].

  3. Homer L, Buchanan KJ, Nasr B, Losty PD, Corbett HJ. Meatal Stenosis in Boys following Circumcision for Lichen Sclerosus (Balanitis Xerotica Obliterans). J Urol. 2014 Jun 30. [Medline].

  4. Litvak AS, Morris JA, McRoberts JW. Normal size of the urethral meatus in boys. J Urol. 1976 Jun. 115(6):736-7. [Medline].

  5. Stewart L, McCammon K, Metro M, Virasoro R. SIU/ICUD Consultation on Urethral Strictures: Anterior urethra-lichen sclerosus. Urology. 2014 Mar. 83(3 Suppl):S27-30. [Medline].

  6. Gargollo PC, Kozakewich HP, Bauer SB, et al. Balanitis xerotica obliterans in boys. J Urol. 2005 Oct. 174(4 Pt 1):1409-12. [Medline].

  7. Brown MR, Cartwright PC, Snow BW. Common office problems in pediatric urology and gynecology. Pediatr Clin North Am. 1997 Oct. 44(5):1091-115. [Medline].

  8. Smith C, Smith DP. Office pediatric urologic procedures from a parental perspective. Urology. 2000 Feb. 55(2):272-6. [Medline].

  9. Frank JD, Pocock RD, Stower MJ. Urethral strictures in childhood. Br J Urol. 1988 Dec. 62(6):590-2. [Medline].

  10. Garat JM, Chechile G, Algaba F, Santaularia JM. Balanitis xerotica obliterans in children. J Urol. 1986 Aug. 136(2):436-7. [Medline].

  11. Persad R, Sharma S, McTavish J, et al. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Br J Urol. 1995 Jan. 75(1):91-3. [Medline].

  12. Sijstermans K, Hack WW, Bos SD, van der Horst HJ. [Urethral meatal stenosis in boys easily overlooked]. Ned Tijdschr Geneeskd. 2005 Dec 10. 149(50):2765-9. [Medline].

  13. Stenram A, Malmfors G, Okmian L. Circumcision for phimosis: a follow-up study. Scand J Urol Nephrol. 1986. 20(2):89-92. [Medline].

 
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