Meatal Stenosis

Meatal stenosis at a glance

  • Meatal stenosis occurs when the meatus, the opening at the tip of the penis (where urine passes through), is narrowed by scarring and abnormal tissue growth caused by irritation.
  • Meatal stenosis generally occurs in boys between the ages of 3 and 7.
  • Meatal stenosis is most commonly associated with circumcision performed on young boys, as the newly exposed tip of the penis constantly rubs against a wet diaper.
  • Meatal stenosis is treatable with a meatotomy, in which the meatus is surgically enlarged.

What is meatal stenosis?

Meatal stenosis is most common in children and occurs when the meatus, the opening of the penis that drains urine from the bladder, is narrowed. This occurs when irritation leads to abnormal tissue growth and scarring across the opening of the urethra. The narrow meatus obstructs urine flow causing an upward deflected or messy spraying of urine, rather than a normal stream. The effect is similar to pressing your finger up to the end of a flowing water hose.

Meatal stenosis causes a host of urinary problems, including painful urination or a narrowed or misdirected urine stream. In some cases, it may be coupled with mild pain or blood while urinating. Meatal stenosis is not an extremely common condition and is treatable through minor surgery. If left untreated, meatal stenosis can lead to kidney problems or a urinary tract infection (UTI).

Symptoms of meatal stenosis

The most common symptoms of meatal stenosis include:

  • A small or narrow urine stream
  • Painful urination
  • Small amounts of blood at the end of the urine stream
  • An upward directed stream of urine
  • Difficulty directing urine stream.

Meatal stenosis among boys is typically diagnosed through a general physical examination. Other tests include a bladder ultrasound, a basic metabolic panel and a urine analysis. Although rare, girls can be diagnosed with meatal stenosis through a voiding cystourethrogram (VCUG) which is a real-time imaging procedure that helps doctors examine how the kidneys, ureters and bladder are working.

Causes of meatal stenosis

Meatal stenosis is caused by chronic irritation of the tip of the penis rubbing against a wet diaper, causing dermal scarring and inflammation in the tissue surrounding the urethral meatus. This occurrence typically happens in young boys who are not yet toilet trained and have just had a circumcision. Meatal stenosis occurs in about 9-10 percent of males who are circumcised.

If a young child has recently been circumcised, it’s a good idea to try and keep the diaper clean and dry. This avoids excessive irritation of the tip of the penis that is now exposed.

Although not as common, meatal stenosis can also occur from ischemia, or a restriction in blood supply to the tissues, after circumcision. It can also occur after surgery for hypospadias repair. Hypospadias occurs when a boy is born with the urethral opening at the underside of the penis rather than the tip.

Treatment of meatal stenosis

During a meatotomy the child is given a general or local anesthetic. The skin that is covering the meatus and has caused it to narrow is cut with fine tipped scissors, which enlarges the opening. In some instances, small stitches are required in order to stop the small blood vessel from bleeding. An ointment is applied to the tip of the penis in order for the skin to heal.

The procedure takes anywhere from 15-30 minutes and can be performed as an inpatient or outpatient surgery. The general recovery time for this procedure is 1 to 2 days. Any pain can be managed by oral analgesics or a warm bath.

Although not highly recommended, meatal stenosis can also be treated through meatal dilation, during which the opening is gently stretched apart with dilation instruments. There are common risks of this method including tearing of the meatus or the recurrence of scarring and meatal stenosis.