Meatal stenosis is a narrowing of the meatus, or the hole where the urine leaves the urethra. The urethra is the narrow tube that carries urine from the bladder to the outside of the body. In males, the urethra ends at the tip of the penis.
When the meatus is constantly irritated, excess tissue growth may narrow the opening. As the opening becomes narrow, the flow of urine becomes restricted. The condition is seen mostly in young circumcised boys but sometimes occurs in adult men. A child may be born with meatal stenosis, especially if there are other abnormalities of the genitals.
If a boy has no other abnormalities of the genitals, meatal stenosis is not usually noticed until the child is toilet trained. Symptoms of meatal stenosis include: burning with urinationdifficulty aiming the stream of urinea forceful but narrow, fine stream of urine that may be deflected upwards or in one directionpainful, frequent urinationa small amount of blood on the underpants or diaper
Adult males with meatal stenosis may have similar symptoms.
Causes of meatal stenosis include: balanitis xerotica obliterans, a condition that causes a discoloration and dryness of the glans of the penisirritation of the meatus from persistent exposure to urineirritation of the penis from the diaper rubbing against the meatal openingother abnormalities of the penis and urethra, such as hypospadiasprolonged use of a urinary catheter, which is a tube put into the urethra to drain urinetrauma to the penis or meatus
In adult men, the condition can be caused by trauma or sexually transmitted infections (STIs).
Meatal stenosis cannot always be prevented. In a recently circumcised boy, frequent diaper changes may decrease the risk.
In adult males, practicing abstinence or having a mutually monogamous relationship for life will eliminate the risk of STIs. Practicing safer sex may decrease the risk of STDs.
Following sports safety guidelines for children, adolescents, and adults can prevent injuries to the meatus.
Diagnosis of meatal stenosis begins with a medical history and physical exam. The severity of the stenosis can be evaluated by attempting to insert a small tube into the urethral opening.
Witnessing stream caliber during voiding is very helpful.
Other tests may be done if there is a history of urinary tract infections. For example, an ultrasound test, a voiding cystourethrogram (VCU), or a CT urogram may be done to better assess the bladder, ureters, kidneys, and upper portion of the urethra.
If left untreated, meatal stenosis may continue to cause discomfort and bleeding with urination.
Meatal stenosis is not contagious and poses no risk to others. If the meatal stenosis is caused by an underlying STI, the infection may be contagious.
In children, meatal stenosis is usually easily treated with meatotomy. A small incision is made in the meatus to enlarge the opening. In some cases, the outside skin may then be sewn to the inside lining of the urethra. In adults with more severe urethral meatal stenosis, a slightly more complex surgical procedure can be done.
Surgery can cause bleeding, infection, and allergic reaction to anesthesia.
The healthcare provider will give specific instructions for care of the meatus and surgery site. An antibiotic ointment may be applied around the meatus. The meatus may also need to be gently opened with a small plastic tube a few times a day for a couple of weeks.
The person may be advised to avoid bicycle riding, contact sports, and activities on playground equipment for a few days. In some situations, no further treatment is necessary. For more complex stenosis or surgery, a person may have further instructions to follow.
The meatus is examined during periodic checkups to make sure the condition does not recur. Any new or worsening symptoms should be reported to the healthcare provider.