Meatal Stenosis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Meatal stenosis is when the meatus, or the opening at the tip of the penis, becomes narrow. The penis plays an important role in excretion and reproduction. It passes urine and sperm out of the body through the urethra (a tubular structure that arises from the urinary bladder and helps pass urine out of the body). The meatus is normally a vertical opening measuring around five millimeters in children and eight millimeters in adults. When the meatus is narrow, it interferes with the normal passage of urine. If there is a significant amount of narrowing, the bladder might not empty, leading to urinary tract infections and other kidney problems. This condition can be present since birth or can appear later. One usually develops meatal stenosis between the age group of three and seven years. It has been found to occur in around nine percent of boys during birth, and around twenty-three percent of the cases occurred after birth.

What Causes Meatal Stenosis?

• Circumcision - This is a small surgical procedure where the foreskin over the head of the penis is removed. Inflammation or swelling occurs when the circumcised penis rubs against a diaper or its skin.

• Glans Ischemia - Reduced blood flow (ischemia) to the head of the penis or glans after circumcision. It can also cause meatal stenosis. Certain techniques used in the procedure, such as injections to numb the area, can reduce blood and oxygen flow to the penis, thus causing glans ischemia.

• Inflammation - The uric acid and ammonia crystals present in the urine can cause inflammation of the meatus over a period, leading to the narrowing of the meatus. Thus, changing a diaper containing an accumulation of uric acid crystals and ammonia is important. This prevents the development of inflammation resulting from the accumulated urine crystals.

• Hypospadias - Hypospadias is a congenital condition where the urethral opening is at the underside of the penis and not at the tip. Meatal stenosis sometimes occurs due to blockage following the hypospadias corrective surgery.

• Injury to the tip of the penis.

• Inflammatory conditions of the penis like balanitis and BXO (balanitis xerotica obliterans).

• Long-term usage of urinary catheters (tubes placed in the penis to drain urine from the bladder in certain conditions).

• In females, the condition has been present since birth.

• Surgeries involving surgical instruments inserted into the urethra can lead to stenosis.

What Are the Symptoms of Meatal Stenosis?

The symptoms of meatal stenosis occur due to the blockage of Urine. The symptoms include:

• Pain or burning sensation after passing urine.

• Sudden urge to urinate.

• Frequent urination.

• A small, thin, very fast stream of urine.

• An upward spray of urine is difficult to aim.

• Trouble in bladder emptying.

• Presence of blood drops at the tip of the penis after passing urine.

How Is Meatal Stenosis Diagnosed?

• Physical Examination - The physician makes a thorough physical examination of the penis. The width of the penis is measured. A small, constricted, and narrow meatus means the passage is blocked.

• Urination Observation - The urination process is observed to determine the path of the urine stream. An uncontrolled spraying urine stream could mean the meatus is narrow and needs correction.

• Rate of Urine Flow - Measuring the urine flow rate can help diagnose the condition.

How Is Meatal Stenosis Treated?

Meatal stenosis should not be self-treated. Trying to expand the meatus manually could be dangerous and lead to tearing, scarring, and further narrowing of the meatus.

Surgery - Meatoplasty is the surgical treatment of meatal stenosis. The procedure is called meatotomy. The outcome of the surgery is permanent.

How Is Meatoplasty Performed?

Meatoplasty is carried out by a urologist under general anesthesia to avoid a painful situation. An incision is made along the length of the meatus to increase its length. The extension of length is kept in place with the help of resorbable stitches that do not have to be removed later.

After the procedure, an antibiotic cream is applied to the sutured area every two hours. A dab of antibiotic ointment is to be inserted into the meatus many times a day. Pain at the site of surgery can be relieved with the oral intake of painkillers or the application of a warm bath. Bleeding is a rare occurrence and can be stopped by applying direct pressure. Water intake should be increased so that the urine is less concentrated and does not irritate the surgical area. Avoid having sour juices and soda. Stinging urine or dysuria that irritates the meatus might be there for the first twenty-four hours. Recovery generally occurs within one to two days. School can be resumed the next day.

What Are the Complications of Untreated Meatal Stenosis?

If left untreated meatal stenosis can lead to complications such as:

• Urinary Tract Infection - Infections present in any part of the urinary tract.

• Kidney problems.

• Involuntary passing of urine.

• Vesicoureteral reflux - This is the condition in which urine backflows from the kidneys to the urinary bladder.

How To Prevent Meatal Stenosis?

Meatal stenosis present since birth can not be prevented. Leaving the penis uncircumcised could remove the chances of one getting the condition. However, not performing circumcision in certain cases can increase the risk of other health problems such as urinary tract infections in kids, sexually transmitted diseases in men, and rarely penile cancer. Regular application of vaseline to the circumcised area might prevent the occurrence of meatal stenosis.

Conclusion

Meatal stenosis is the narrowing of the tip of the penis. It can be present at birth or acquired. It is one of the complications of the procedure of circumcision. Not undergoing circumcision might help keep the condition at bay, but circumcision is needed in certain cases. The decision to circumcise depends upon the prevalent condition or beliefs. The surgery to correct meatal stenosis has a good outcome if proper follow-up measures are taken per the doctor’s recommendation. Meatal stenosis cannot be prevented if present at birth. There are a few risks involved with the condition. The overall prognosis of the treatment is good, and it is not life-threatening if diagnosed and treated at an early stage.