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Meatal Stenosis

Sometimes the opening of the penis where urine passes can become blocked and can cause various problems with urination. The following information should help you understand this condition and how it can be treated.

What is meatal stenosis?

Meatal stenosis is an abnormal narrowing of the urethral meatus in males. This refers to the size of the opening at the tip of the penis. This condition is usually acquired but can exist from birth.

What are some risk factors for meatal stenosis?

Meatal stenosis is most commonly associated with circumcision and is rarely seen in uncircumcised males. It is likely that the newly exposed tip of the penis (including the meatus) suffers mild injury as it rubs against a diaper or the child's own skin. Over time this chronic irritation can result in scarring and a narrowing of the meatus. It can also result from mild ischemia that occurs with circumcision. Meatal stenosis can also occur after hypospadias repair. While this is uncommon, it can present in up to 4% of patients undergoing surgery to correct hypospadias. Injury to the tip of the penis, inflammatory skin conditions (including balanitis and BXO), or prolonged use of urinary catheters can also increase the risk of meatal stenosis.

What are symptoms of meatal stenosis?

Meatal stenosis can present with many different symptoms related to a partially obstructed urinary stream. These include pain or burning with urination, urgency of urination, frequency of urination, as well as a urinary stream that sprays or is difficult to aim, or a small drop of blood from the meatus at the time of completion of urination.

How is meatal stenosis diagnosed?

Physical exam will reveal a small, narrowed meatus. This should correlate with urinating symptoms of urinary obstruction. Upon close inspection, the lower surface of the meatus is often adhered. Measuring the meatus is often unnecessary and will expose the patient to further risk of injury.

How is meatal stenosis treated?

Surgical intervention with a meatotomy, an incision to enlarge the meatus, is the most reliable treatment. This procedure involves sharply dividing the lower surface of the meatus. Recurrence of stenosis after meatotomy is rare, as long as appropriate care is provided by the parent. Dilation of the urethral meatus can result in tearing of the meatus. While this may provide short-term improvement in symptoms, the resultant scarring usually causes more severe symptoms and a narrower meatus.

What can be expected after treatment?

Meatotomy is a very effective treatment for meatal stenosis. Pain at the tip of the penis can be managed with oral analgesics or warm baths. Bleeding is rare and usually controlled with direct pressure. Recovery time is rapid, typically one to two days. Applying a lubricating ointment or petroleum jelly to the tip of the penis can aid in patient discomfort and wound healing.