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Summary

Meatotomy is a minor procedure for the treatment of meatal stenosis, a condition that causes narrowing of the tip of the penis, resulting in difficulty passing urine. Meatal stenosis may either be present since birth or acquired during the early years of life. This condition is prevalent in young boys who have undergone circumcision. The meatotomy surgery helps to enlarge the opening of the penis to allow the urine to pass freely. The surgery is either performed in the surgeon’s office or operating room, depending on the cooperation and tolerance of the child. The wound takes about one to two weeks to heal after the surgery. The procedure is safe and is associated with a low recurrence rate.

  1. What is meatotomy?
  2. Why is meatotomy recommended?
  3. Who can and cannot get meatotomy?
  4. What preparations are needed before meatotomy?
  5. How is meatotomy done?
  6. How to care for yourself after meatotomy?
  7. What are the possible complications/risks of meatotomy?
  8. When to follow up with your doctor after a meatotomy?

Meatotomy is a minor surgical procedure that is used to treat meatal stenosis.

Meatal stenosis is a condition that causes the opening of the penis, called the meatus, to become narrow. This condition may be present since birth or develop due to other factors like injury or inflammation. It is more common in young boys who have undergone circumcision (surgery to remove the foreskin, a skin covering the head of the penis) than those who have not. The circumcision may cause a mild injury in the exposed tip of the penis, which results in the narrowing of the meatus (stenosis).  

Also, during circumcision, the blood flow towards the penis may decrease and can cause narrowing of the meatus. Another common cause of the narrowing of the meatus are the ammonia and uric acid crystals present in urine. The presence of these crystals in the diaper can result in low-grade inflammation and gradual narrowing of the meatus.

Additionally, rubbing of the exposed tip of the penis against the diaper after circumcision, causing tissue injury, is a possible cause of meatal stenosis.

Narrowing of the meatus can cause difficulty in passing urine, pain in the penis, and the urine to spray in different directions while urinating. Meatotomy provides relief from these symptoms by enlarging the meatus and allowing the person to pass urine easily.

This surgery is recommended in males affected by meatal stenosis, especially circumcised males. Meatal stenosis may show up between three to seven years of age in such boys and has the following symptoms:

The surgery can be done before the age of one year or later, whenever the condition shows up.

The surgery is performed by applying a special numbing cream (the child will be awake during the procedure) or under general anaesthesia (the child will be unconscious during the procedure). The surgeon may not use the numbing cream (EMLA cream) if the child has a history of idiopathic or congenital methemoglobinemia (a condition in which RBCs have a lot of methamglobin and supply less oxygen to tissues). General anaesthesia is used with caution in children with lung diseases, heart problems, or kidney diseases.

A physical examination will be performed to detect meatal stenosis. The doctor may ask you to share the list of all the medicines that your child takes. You may be asked to discontinue some of them one week before the surgery. You should not give the child anything to eat or drink six hours before the scheduled time of the operation.

If your child is co-operative, the surgery will be performed in the doctor’s office. You will be allowed to stay with the child to provide reassurance during the surgery. The procedure usually involves the following steps:

  • The surgeon will apply a special numbing cream over the head of the penis and cover it with an occlusive dressing (a medical bandage that is water and airtight). He/she will allow the cream to stay for about 30 minutes.
  • After 30 minutes, the surgeon will remove the dressing and prepare the penis for surgery.
  • He/she will use a special clamp (an instrument used to fasten or hold things together tightly) to crush a part of the meatus.
  • The surgeon will then use a special scissor to divide the crushed area and enlarge the meatus.
  • Finally, he/she will cover the area with an antibiotic ointment.

If your child cannot tolerate this procedure, the surgery will be performed under general anaesthesia in the operating room. Your child will be discharged on the same day of surgery with special post-operative instructions.

It is normal for the child to experience the following after surgery:

  • Burning sensation while peeing for two to three days
  • Slight swelling at the operated site for two to three days
  • Mild fever
  • Small blood spots on the underwear
  • Vomiting on the first day of the surgery
  • Spraying of urine for the first two weeks after surgery
  • Splitting of urine into two streams for the first two weeks following surgery
  • Behavioural changes such as changing sleeping patterns and bedwetting for up to two weeks after surgery

The following precautionary measures will need to be taken after meatotomy:

  • Avoid sports, swimming, bike riding, swings, and straddle toys for the first two weeks after surgery.
  • You should check your son’s penis every three to four hours for swelling, bad odour, bleeding, or the presence of pus.
  • Your child can take short tub baths or showers two days after surgery.
  • Your child can start with a liquid diet such as juice and water and gradually move on to solid foods in a small quantity. Avoid greasy or high-fat foods such as pizza and hamburgers for a day following surgery.
  • If the child vomits after surgery, make them lie still and allow their stomach to settle for about 30 to 60 minutes before offering clear fluids. Vomiting may occur due to medicines or pain
  • The surgeon may prescribe pain medications if the child experiences severe pain.
  • Encourage your child to urinate frequently during the initial 24 hours following surgery, preferably every three to four hours. Normally urination usually starts within a day after the surgery.
  • It may take about one to two weeks for the wound to completely heal after surgery.

Meatotomy is a safe procedure for meatal stenosis and the chances of recurrence of the condition are very low after the surgery. The surgery treats meatal stenosis and improves the flow of urine.

When to see the doctor?

You should contact the surgeon if your son shows any of the following symptoms:

  • Persistant swelling at the site of operation
  • Infection at the site of operation
  • Fever with a temperature of 101°F or more
  • Bleeding (spread over 2 inches diameter area on the underwear or diaper)
  • Vomiting for several hours
  • Behavioural changes for more than four weeks

The complications associated with this surgery are rare; however, meatotomy is also associated with a few risks like all other surgeries. Possible complications of the procedure include:

  • Infection
  • Bleeding
  • Problems passing urine in a normal stream
  • Need for more surgery

A follow-up is usually not required after this procedure. However, it can be scheduled if symptoms of meatal stenosis reoccur.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

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  2. Urology Care Foundation [Internet]. American Urological Association. Maryland. US; What is Meatal Stenosis?
  3. UW Health: American Family Children's Hospital [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; Meatal Stenosis/Meatotomy
  4. Cleveland Clinic. [Internet]. Cleveland. Ohio. US; Meatoplasty/Meatotomy
  5. Priyadarshi V, Puri A, Singh JP, Mishra S, Pal DK, Kundu AK. Meatotomy using topical anesthesia: a painless option. Urol Ann. 2015 Jan-Mar;7(1):67–70.
  6. American Society of Anesthesiologists [Internet]. Washington DC. US; Types of Anesthesia
  7. Smith G, Goldman J. General Anesthesia for Surgeons. [Updated 2020 Feb 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  8. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Meatotomy - Child
  9. Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). 2006 Jan-Feb. 45 (1):49-54. PMID: 16429216.
  10. Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013. Surgeon. 2018 Apr. 16 (2):107-118. PMID: 28017691.
  11. Morris BJ, Krieger JN. Does Circumcision Increase Meatal Stenosis Risk?-A Systematic Review and Meta-analysis. Urology. 2017 Dec. 110:16-26. PMID: 28826876.
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  15. Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol. 2011 Oct. 7 (5):526-8. PMID: 20851685.
  16. Homer L, Buchanan KJ, Nasr B, Losty PD, Corbett HJ. Meatal stenosis in boys following circumcision for lichen sclerosus (balanitis xerotica obliterans). J Urol. 2014 Dec. 192 (6):1784-8. PMID: 24992332.
  17. Stewart L, McCammon K, Metro M, Virasoro R. SIU/ICUD Consultation on Urethral Strictures: Anterior urethra-lichen sclerosus. Urology. 2014 Mar. 83 (3 Suppl):S27-30. PMID: 24268357.
  18. Litvak AS, Morris JA Jr, McRoberts JW. Normal size of the urethral meatus in boys. J Urol. 1976 Jun. 115 (6):736-7. PMID: 940216.
  19. Fronczak CM, Villanueva CA. Clinic meatotomy under topical anesthesia. J Pediatr Urol. 2017 Oct. 13 (5):499.e1-499.e3. PMID: 28365169.
  20. Godley SP, Sturm RM, Durbin-Johnson B, Kurzrock EA. Meatal stenosis: a retrospective analysis of over 4000 patients. J Pediatr Urol. 2015 Feb. 11 (1):38.e1-6
  21. Monroe Carell Jr. Children's Hospital at Vanderbilt [Internet]. Tennessee. US; Meatotomy
  22. Oregon Health and Science University [Internet]. Oregon. US; Home care following meatotomy or meatoplasty
  23. University of Maryland Children's Hospital [Internet]. Maryland. US; Meatoplasty - FAQs
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