Meatal stenosis
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'''Urethral meatal stenosis''' is a narrowing ([[stenosis]]) of the opening of the [[urethra]] at the external [[urinary meatus|meatus]], thus constricting the opening through which [[urine]] leaves the body from the [[urinary bladder]].
==Causes, incidence, and risk factors==
Many authors have stated that meatal stenosis in males is caused by [[circumcision]]. It occurs in 0.9% [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16649052&query_hl=1&itool=pubmed_docsum]- 10% [http://www.emedicine.com/PED/topic2356.htm] of circumcised males and, according to Van Howe, is generally only found in circumcised males.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16429216&query_hl=3&itool=pubmed_docsum] When the meatus is not covered by the [[foreskin]], it can rub against urine soaked diapers resulting in inflammation and mechanical trauma. Eventually, the delicate [[epithelial]] lining of the outer urethra is lost, leaving only a pinpoint hole at the tip of the glans. Meatal stenosis may also be caused by damage to the [[frenulum|frenular]] artery during circumcision. [http://www.emedicine.com/PED/topic2356.htm]
[http://www.cirp.org/library/complications/persad/] [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16429216&query_hl=3&itool=pubmed_docsum] Meatal stenosis may also be associated with [[phimosis]] in uncircumcised males.[http://www.cirp.org/library/anatomy/parkash/] It may also be caused by [[lichen sclerosus]].[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12175386&query_hl=29&itool=pubmed_docsum]
In females, this condition is a [[congenital disorder|congenital]] (present from [[childbirth|birth]]) abnormality which can cause [[urinary tract infection]]s and bed-wetting ([[enuresis]]).
==Symptoms ==
* Abnormal strength and direction of urinary stream
* Visible narrow opening at the meatus in boys
* Discomfort with urination ([[dysuria]] and frequency)
* [[Urinary incontinence|Incontinence]] (day or night)
* Bleeding ([[hematuria]]) at end of urination
* Urinary tract infections
==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:
* [[Urinalysis|Urine analysis]]
* Urine culture
* CBC, basic metabolic panel
* 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. [http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1464-410X.2003.04680.x]
==Prognosis==
Most people can expect normal urination after treatment.
==Complications ==
Persistent urinary problems including abnormal stream, [[pain]]ful urination, frequent urination, urinary incontinence, blood in the urine, and increased susceptibility to urinary tract infections can be complications.
==Prevention==
"In a recently circumcised male infant, try to maintain a clean, dry diaper and avoid any exposure of the newly circumcized penis to irrititants (sic)." [http://www.nlm.nih.gov/medlineplus/ency/article/001599.htm]
Meir and Livne suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]", [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15118434&query_hl=21&itool=pubmed_docsum] while Jayanthi recommends the use of a modified Snodgrass hypospadias repair.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14501672&query_hl=21&itool=pubmed_docsum] Viville states that "prevention is based essentially upon more caution in the use of indwelling urethral catheters."[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7310161&query_hl=21&itool=pubmed_docsum]
==Source==
* [http://www.nlm.nih.gov/medlineplus/ency/article/001599.htm Meatal stenosis]. MedlinePlus Medical Encyclopedia. Public domain text.
* [http://www.emedicine.com/PED/topic2356.htm Meatal stenosis]. Carlos A. Angel, MD
[[Category:Urology]]
[[Category:Surgery]]
[[de:Meatusstenose]]