History
The patient history may include the following:
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Difficult-to-aim (upward-deflected), high-velocity (long-distance) stream of urine; the misdirection of the urine stream is the most important feature of the history, in that this is what is most likely related to meatal stenosis and is most reliably corrected by meatotomy or meatoplasty; this is the most common presentation
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Some families also note lateral misdirection of the stream, which may be due to rotational torsion of the penis or twisting of the penis by the child during urination
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Pain upon initiation of micturition
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Need to stand back from toilet or sit during urination
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Burning at meatus
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Blood spots in underwear
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Urgent, frequent, and prolonged emptying of the bladder
It is important to note that symptoms other than misdirection of the urinary stream (eg, pain, urinary hesitancy, and frequency) may be signs of underlying voiding dysfunction rather than results of meatal stenosis. Consequently, these symptoms may not improve after correction of the meatal stenosis.
Physical Examination
Meatal stenosis can be suspected on the basis of the presence of a small meatus during examination, particularly if, with lateral traction, the ventral edges of the meatus appear fused. However, a small-appearing meatus may be asymptomatic.
Observing an upwardly deflected narrow stream during urination is the most definitive examination finding; this demonstrates the clinical sign most reliably corrected with surgery.
The physician may desire to calibrate the meatus. Litvak et al reported that the meatus in children younger than 1 year will accept a lubricated 5-French feeding tube; they also reported that in children aged 1-6 years, an 8-French feeding tube should pass without difficulty. [12]
