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Meatal Stenosis Treatment & Management

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

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.[7]

  • 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). [8]
  • 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, 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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