The penis is a part of the male genitalia that plays an integral role in reproduction and urologic function. A thin, narrow tube called the urethra is located in the center of the penis, which carries both urine and sperm from the respective organs outside the body. The small opening at the head of the penis is referred to as the “meatus.” In normal circumstances, the width of the meatus is the same as the urethra. This allows for optimal excretion of bodily fluids. However, there are instances where the opening towards the end of the penis becomes increasingly narrow, which can cause blockages or difficulties with urination. This condition is called meatal stenosis. To help you further understand symptoms, causes, and prognosis, here’s everything you need to know about meatal stenosis.
What Causes Meatal Stenosis?
Meatal stenosis tends to affect about 9% of boys at birth. However, one study found that upon visual inspection, about 32% of boys between the ages of 6 and 10 had the appearance of meatal stenosis. This suggests that it’s more common for aging boys to develop this condition over time. To understand why this happens, consider some of the most common causes.
Circumcision
In almost every cause of meatal stenosis, the male has been circumcised. During circumcision, the foreskin that protects the head of the penis is removed, thus exposing the meatus. There are several reasons that circumcision may increase the risk for this condition, but it’s quite rare for uncircumcised males to experience it.
Glans Ischemia
Ischemia is a condition that’s characterized by a reduction or restriction in blood flow, thus decreasing the amount of oxygen an area receives. When this happens on the penis, it can cause meatal stenosis. The risk for ischemia is greatest during the procedure used in circumcision when numbing injections are involved.
Injury
Technically, circumcision is a type of injury to the meatus, which is located on the head of the penis. While this is one of the most common causes for this condition, other injuries that affect the opening could also lead to the development of meatal stenosis. If your child has suffered a penile or testicular injury, see your doctor to monitor healing and catch early symptoms of complications.
Hypospadias Treatment
There are several birth defects that can affect the penis. One of which, hypospadias, causes the penis to develop in an abnormal manner. This could lead to the meatus being located on the side, or underside, of the penis. During corrective surgery, meatal stenosis can occur.
Inflammation
Inflammation is another common cause of meatal stenosis. The uric acid and ammonia crystals present in urine (and many kidney stones) lead to prolonged periods of inflammation that trigger narrowing. During infancy, changing your baby’s diapers in a timely manner can help reduce the risk of complications and lower the buildup of any urine crystals.
Long-term catheter use may also be a contributing factor to the development of meatal stenosis, especially later in life. If you need to use a catheter, or need to perform pediatric catheterization on your child, talk to your doctor about what you can do to ensure safe insertion and reduce the risk of complications.
Signs and Symptoms of Meatal Stenosis
Meatal stenosis can be present at birth or occur later in life. However, most males who develop this condition tend to begin experiencing symptoms between the ages of 3 and 7. Parents should pay special attention to any complaints or discomfort expressed by their boys during this age group. If there are any of the following symptoms present, schedule an appointment with your doctor or pediatrician to undergo the proper diagnosis. These symptoms can also be representative of other common urologic conditions, so a medical evaluation is necessary. Some of the most common signs and symptoms include:
- Pain or burning during urination
- Sudden urges to urinate (urgency)
- Frequent need to urinate
- Trouble emptying the bladder (urinary retention)
- The presence of blood after urinating
- Small, narrow, fast urine stream
- Urine flow that sprays upwards
- Urine flow that’s difficult to aim
If you notice any of these signs or symptoms in yourself or your child, contact your urologist as soon as possible. Swift treatment is the best way to prevent further complications and ongoing discomfort.
Complications of Untreated Meatal Stenosis
When treatment isn’t performed, it can lead to a variety of complications. However, there is differing opinions about these complications in the medical community. Rather than taking the risk, talk to your urologist for the best course of action. Some potential problems that can arise from untreated meatal stenosis include kidney issues, involuntary urination (urinary incontinence), backflow of urine (vesicoureteral reflux), and recurrent urinary tract infections. If the only symptom that indicates meatal stenosis is appearance related, these complications are less likely to occur.
Can Meatal Stenosis Be Prevented?
Unfortunately, meatal stenosis cannot be prevented. The only thing that would lower the risk of it occurring is to forego circumcision at birth. However, not having your child circumcised may simultaneously increase the risk of other health problems over time. Uncircumcised men are more likely to develop UTIs and may be more prone to catching sexually transmitted diseases. In comparative science, penile cancer also seems to be slightly elevated in men who have not been circumcised, but there are several preventative measures available to offset this risk.
Choosing to circumcise your child tends to have more benefits than risks. During the follow up care, you may be advised to apply Vaseline regularly to help with healing. This could potentially reduce the occurrence of meatal stenosis caused by the procedure.
Treatment Options
When meatal stenosis does develop, don’t worry. There are several available treatment options to help you care for your child and correct the issue. The first step in treatment is getting the proper diagnosis from your pediatrician, doctor, or urologist. Diagnostics begins with a physical exam, which is usually enough. However, some people have naturally narrower meatal widths, so if there are no associated symptoms you may be asked to wait and actively monitor its development for signs of an issue.
Treatment options may vary depending on severity and age of the affected individual. One of the most effective ways to treat meatal stenosis and ensure the meatal width does not continue to change is through surgery. During the procedure (called a meatotomy), a surgeon will cut the bottom part of the meatus that’s stuck. It’s usually a fairly quick procedure and long-term results are promising.
After surgery, it’s important to properly care for the wound until it heals. This should take about two to three weeks. If you received the meatotomy, take extra measures to stay hydrated. If your child received the meatotomy, hydration is still important but may be more difficult depending on their willingness to drink water regularly. Your doctor can recommend ways to help improve hydration during this time to aid in proper healing. You’ll also need to use an antibiotic cream or jelly on the surgical site to reduce the risk of infection. Keep an eye out for any pus, extreme pain, or signs of a fever, which could be indicative of infection.
Your doctor may also recommend an alternative treatment involving gradual dilation of the meatus. This includes stretching the opening wider slowly over time. This method of treatment is not as widely used, as it can lead to tearing, scar tissue, and worsened symptoms over time. For long-term relief of symptoms, a meatotomy is recommended instead.
If you or your child shows symptoms of meatal stenosis, talk to your urologist and undergo the proper diagnosis. This is the best way to address any discomfort and reduce the risk of further complications. Regardless of the age of your child, Byram Healthcare has a range of pediatric catheters and supporting supplies to help make pediatric urology treatments at home as easy as possible. For management of chronic conditions, Byram Healthcare has the products and support you need to live a happy, healthy life. Our mission is to help improve health outcomes and affordability of care for people living with chronic diseases.
Byram Healthcare is a member of the National Association for Continence’s Trusted Partners Program, whose mission is to provide quality continence care through education, collaboration and advocacy. We continue to build partnerships in the clinical community to ensure we focus on what’s best for the patient.
