Meatal Stenosis

By Philip E. Gleason, MD

 

I wanted to provide you with some information regarding urethral meatal stenosis. Meatal stenosis is a narrowing of the opening of the urethra at the tip of the penis. There is often a web of tissue along the bottom side of the opening of the urethra that produces a narrowing. Instead of being a nice, wide open, elliptical opening, the opening is narrowed and the urine can be deflected. No one knows exactly what causes the meatal stenosis. It may be some inflammation and irritation from healing after circumcision as it most commonly occurs in boys who are circumcised. However, it can occasionally occur in boys who are not, as well. It may not produce any symptoms at all. It can, however, produce difficulties with urination. Oftentimes, following toilet training, the boys will do quite well for a period of time. They then may develop some somewhat irritative symptoms including excessive urinary frequency (voiding very often) as well as urgency, in which they have the feeling and the need to void and can barely control or hold it. When they do void, they may be having a little pain or discomfort, burning, or irritation with voiding. Oftentimes, the family notices that the urine stream itself is somewhat deflected in an upward direction. For the boys to hit the toilet, they have to more or less aim down at the floor or at their feet. If they aim at the toilet itself, they oftentimes will hit the back of the toilet or even the wall. Oftentimes, in retrospect, the family notes that they have been having trouble hitting the toilet for quite some time. They may also have some blood in the urine as well. This seems to produce some irritation of the urethral which may, in fact, cause the tissue to become somewhat more scarred and even more narrowed and produce an ongoing cycle of irritation and narrowing, etc.

If meatal stenosis is causing symptoms, we would oftentimes try to open that narrowing. This can be done in one of two fashions. Sometimes if the children are old enough and cooperative, we can apply some EMLA cream to the glans or head of the penis. This is an anesthetic cream. It soaks into the skin. It does take a while to soak into the skin and numb up the skin, and we will often see you in the late morning to apply the cream and maybe leave that on for at least 1-1 hours or even two hours over lunch. This will then numb up the opening of the urethra, and we can nick that skin and open up that web of skin to provide a nice, wide open, elliptical urethral meatus. Alternatively, if the children are not old enough or cooperative at this time, or if there is concern about emotional trauma over the procedure in the office, we sometimes perform that at the hospital. It is a very minor, brief out patient procedure in which the child comes to the hospital in the morning, has a brief general anesthetic allowing us to again nick that ventral web tissue and open up the urethra. We then typically sew the edges of the urethral mucosa to the glans tissue to avoid re-stenosis, re-scarring, or narrowing of the meatus. We sometimes perform cystoscopy looking into the urethra at the same time with a general anesthetic just to make sure there is nothing else inside the urethra or bladder causing difficulties. The children typically bounce back from the procedure very quickly. They oftentimes complain of a little bit of burning or discomfort the first time or two when passing urine, but for the most part are healing and essentially back to normal in just a day or so. The urethral meatus, once opened, remains open. It is unusual to have a secondary scar or stricture form and for the most part, this is a procedure that can be performed once and lasts for the rest of the life.

Again, I hope this provides some introductory information regarding meatal stenosis and its symptoms and treatment. If we can provide any further information or answer and questions, please let us know.

 

© 2005-2010, Dr. Philip E. Gleason, MD