Meatal Stenosis Treatment & Management

  • Author: Carlos A Angel, MD; Chief Editor: Marc Cendron, MD   more...
 
Updated: Jan 11, 2012
 

Surgical Care

Serial dilatation results in small tears of the meatus, which are followed by secondary healing. In the long term, this creates a tighter stricture at the tip of the penis; therefore, this procedure is discouraged.

Meatotomy is the definitive treatment for meatal stenosis. Meatotomy is a simple procedure in which the ventrum of the meatus is crushed (for hemostasis) for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors.

Brown et al reported excellent results following 130 office meatotomies with only 2 recurrences of meatal stenosis and 1 patient with bleeding requiring stitches. They also cited the cost-effectiveness of this treatment and noted good patient tolerance when a caring approach is used to reassure the child before and during the procedure. In this series, parents were encouraged to remain with the children during the operation, as their presence seemed to have a calming effect.[5]

  • If the caregivers and the patient are cooperative, this procedure can be performed in the office of the physician using a topical eutectic mixture of local anesthetics (EMLA cream) applied liberally over the entire glans and secured in place for at least one hour with an occlusive dressing.
  • After being in place for one hour, the dressing is removed and the penis is prepared and draped into a sterile field.
  • Throughout this procedure, reassure the child and tell him what is being done.
  • Introduce one blade of a straight mosquito hemostat into the meatus and crush the ventrum of the meatus (approximately 3 mm) by closing the hemostat. This provides adequate hemostasis in most cases.
  • Divide the crushed area with a straight fine-tipped scissor and apply an antibiotic ointment.
  • After the operation, it is critical that the caregivers separate the edges of the meatus and apply antibiotic ointment or petroleum jelly twice a day for 2 weeks and then once a day for another 2 weeks to prevent one side of the meatotomy from adhering to the other side. Some medical professionals recommend dilation with a lubricated feeding tube or the tip of an ophthalmic ointment tube for a period of 4-8 weeks.
  • In a survey of office pediatric urologic procedures, which included meatotomy, lysis of labial adhesions, and newborn circumcision, Smith and Smith (2000) found that 95 of 99 parents stated that they were satisfied with their decision to have these procedures performed in the office, and 95% reported good outcomes (only 1 patient had recurrent meatal stenosis).[6]
  • Mild dysuria may be present for 1-2 days after meatotomy. If dysuria results in urinary retention, placing the child in a tub of warm water may stimulate micturition.
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Consultations

If the primary care physician is unwilling to perform a meatotomy, encourage consultation with a pediatric urologist.

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Activity

After meatotomy, instruct caregivers to dress the child in loose underwear for 24 hours.

Restrict activities, such as contact sports, bicycle rides, and playground activities, for 3-4 days.

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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, British Association of Paediatric Surgeons, Children's Oncology Group, International Children's Continence Society, International Pediatric Endosurgery Group, New York Academy of Sciences, Society of Critical Care Medicine, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and National Kidney Foundation

Disclosure: Nothing to disclose.

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 and 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, and American Urological Association

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

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, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology

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. Oct 2011;7(5):526-8. [Medline].

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

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

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

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

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

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

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

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

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

  11. 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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