Meatal stenosis: narrowing of the urinary opening

What is meatal stenosis?

The meatus is the outer opening of the urethra on the head of the penis. Its narrowing is called meatal stenosis.

It almost always develops after circumcision. Without the foreskin, the head of the penis and the urinary opening are exposed to rubbing and irritation from diapers and clothing. Repeated inflammation causes scarring at the edges of the urinary opening, and the opening narrows. Sometimes it is noticed years after circumcision, after toilet training.

Symptoms

• the urine stream is thin, forceful and directed upward or shoots far, and the child cannot aim straight into the toilet,
• urinating takes a long time,
• burning and pain when urinating,
• one or two drops of blood at the end of urination or in the underwear,
• the urinary opening looks small, like a pinpoint.

Diagnosis

The diagnosis is made by examination and by watching the urine stream. When needed, the urine flow is measured with uroflowmetry, and an ultrasound is used to check for urine left in the bladder after urinating.

Treatment

The main treatment is meatotomy or meatoplasty: the lower edge of the urinary opening is cut and the edges are stitched to widen the opening. The procedure takes 10–15 minutes, is usually done in children under brief general anesthesia, and the child goes home the same day.

After surgery, an ointment is applied to the urinary opening for a few weeks so that the edges do not stick together again.