Approach Considerations
In general, meatal stenosis does not cause urinary tract infections, hydronephrosis, or any form of obstruction of the lower urinary tract. For this reason, no further urologic investigation is typically warranted, particularly if the only complaint is misdirection of the urine stream.
If the diagnosis is in question, observing the child void, with particular attention to the force of the stream (increased), the caliber of the stream (decreased), and the duration of the voiding episode (usually prolonged), is helpful. If an elimination disorder is suspected, noninvasive urodynamic studies (eg, as uroflow with electromyography [pad electrodes]) and measurement of bladder capacity and postvoid residuals may be helpful for confirming the diagnosis. If associated infection is suspected, urinalysis should be obtained. If the urinalysis is positive, a urine culture should be obtained.
Imaging Studies
In most cases of meatal stenosis, no imaging studies are recommended. Assessment of postvoid residual volume may be considered if there is concern about incomplete bladder emptying.
Staging
No universal standard staging or grading system has been adopted. A 2020 paper by Mekayten et al attempted to establish a validated grading system with three grades of meatal stenosis, as follows [13] :
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Grade 0 - No meatal stenosis, meatus wide open with good visualization of mucosa
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Grade 1 - Narrowed meatus, some visualization of mucosa, visible scar across part of the meatus
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Grade 2 - Pinpoint meatus, no visualization of mucosa, meatus nearly covered with scar tissue
A standardized grading system may improve documentation and communication between healthcare providers and families. The actual effect on clinical outcomes, however, remains unclear.
