Meatal Stenosis Treatment & Management
- Author: Carlos A Angel, MD; Chief Editor: Marc Cendron, MD more...
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.
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). 
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.
If the primary care physician is unwilling to perform a meatotomy, encourage consultation with a pediatric urologist.
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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