(1)
Pediatric Surgery, Al Azher University, Cairo, Egypt
Abstract
Meatal stenosis is a common condition manifested with a severely narrowed distal urinary opening, which interfere with normal micturition and proper complete bladder evacuation, and if it is not recognised and treated early, it may end with a dismal sequels of proximal urinary tract obstruction and even renal failure.
Keywords
Meatal strictureMeatal ulcerMeatotomyMeatoplastyDefinition
Meatal stenosis is a common condition manifested with a severely narrowed distal urinary opening, which interfere with normal micturition and proper complete bladder evacuation, and if it is not recognised and treated early, it may end with a dismal sequels of proximal urinary tract obstruction and even renal failure [1].
Nomenclature
Urethral meatal stenosis.
21.1 Incidence
In many neonates presented with meatal stenosis it may be difficult to define if this stenosis is a congenital anomaly or an acquired disease, as it is exceedingly rare in uncircumcised children, but it is estimated in 9–10 % of males who are circumcised [2]. In a prospective study Van Howe [3] found meatal stenosis in 24 of 239 (7.29 %) circumcised children older than 3 years, making meatal stenosis the most common complication of circumcision.
21.2 Etiology
21.2.1 Congenital
Secondary to failed regression of the distal urethral membrane, which is the border between the ingrown ectodermal tissue of the glans and endodermal tissue of the urethral mucosa, very rarely the stenosis appear as a congenital stricture of perpetual orifice (Fig. 21.1). Meatal stenosis occurs primarily in neonates with coronal or subcoronal hypospadias (Figs. 21.2 and 21.3). Also, congenital meatal stenosis may be an association or manifestation of parameatal cyst (Chap. 19), megalourthera (Chap. 26), anterior urethral valve in the fossa navicularis [33], urethral cyst (Chap. 30), urethral polyp (Chap. 32) or Lacuna Magna anomaly (Chap. 34).
Fig. 21.1
Meatal stenosis at the level of perpetual orifice
Fig. 21.2
Severe meatal stenosis, admitting only a size 3 F ureteric catheter in a 2 years old child with glandular hypospadias
Fig. 21.3
Same case in Fig. 21.2 after repair of glandular hypospadias and meatoplasty around size 8 F catheter
21.2.2 Acquired
Acquired cases after neonatal circumcision, balanitis and urethritis; where a significant inflammatory reaction causing severe meatal inflammation and cicatrix formation, which results in a narrow meatus, a membranous web across the ventral aspect of the meatus, or an eccentric healing process that produces a prominent lip of ventral meatal tissue, and in countries where circumcision is done routinely for almost all neonates, meatal stenosis is seen frequently as a common complication [2]. Meatal stenosis after circumcision is usually due severe napkin rashes, ammoniacal balanitis of the uncovered glans penis resulting in meatal ulcers, which heals by fibrosis (Fig. 21.4). Another hypothetical cause is ischemia due to damage to the frenular artery during circumcision, resulting in poor blood supply to the meatus with a subsequent stenosis [5].
