External Meatal Stenosis

What Is It ?

Urethral meatal stenosis or urethral stricture is a narrowing (stenosis) of the opening of the urethra at the external meatus (pronounced), thus constricting the opening through which urine leaves the body from the urinary bladder.

Symptoms
  • Abnormal strength and direction of urinary stream
  • Visible narrow opening at the meatus in boys
  • Discomfort with urination (dysuria and frequency)
  • Incontinence (day or night)
  • Bleeding (hematuria) at end of urination
  • Urinary tract infections - increased susceptibility due to stricture
Signs and Tests

In boys, history and physical exam is adequate to make the diagnosis. In girls, VCUG (voiding cystourethrogram) is usually diagnostic. Other tests may include: Urine analysis,Urine culture, CBC, basic metabolic panel and Renal and bladder ultrasound.

Treatment

In females, meatal stenosis can usually be treated in the physician's office using local anesthesia to numb the area and dilating (widening) the urethral opening with special instruments.

In boys, it is treated by a second surgical procedure called meatotomy in which the meatus is crushed for 60 seconds with a straight mosquito hemostat and then divided with fine-tipped scissors. Recently, home-dilation has been shown to be a successful treatment for most boys.

Prevention

"In a recently circumcised male infant, try to maintain a clean, dry diaper and avoid any exposure of the newly circumcised penis to irritants."

Meir and Livne suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]", while Jayanthi recommends the use of a modified Snodgrass hypospadias repair. Viville states that "prevention is based essentially upon more caution in the use of indwelling urethral catheters."

Circumcision

Studies have indicated that male circumcision contributes to the development of urethral stricture. Among circumcised males, reported incidence figures include 0.9%, 2.8%, 7.29%, 9-10%, and 11%.In Van Howe's study, all cases of meatal stenosis were among circumcised boys.When the meatus is not covered by the foreskin, it can rub against urine soaked diapers resulting in inflammation and mechanical trauma. Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.

In non-circumcised males, meatal stenosis can occur where phimosis or lichen sclerosus is present.In females, this condition is a congenital abnormality which can cause urinary tract infections and bed-wetting.