Urethral meatal stenosis or urethral stricture is a narrowing (stenosis

Stenosis

A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....

) of the opening of the urethra

Urethra

In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

 at the external meatus

Urinary meatus

The urinary meatus is an orifice of the urethra. It is the point at which urine and, in males, semen exits the urethra. The meatus features varying degrees of sensitivity to the touch among males and females....

 (icon), thus constricting the opening through which urine

Urine

Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...

 leaves the body from the urinary bladder

Urinary bladder

The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...

.

Causes, incidence, and risk factors

Studies have indicated that male circumcision

Circumcision

Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....

 contributes to the development of urethral stricture. Among circumcised males, reported incidence figures include 0%, 0.01%, 0.55%, 0.9%, 2.8%, 7.29%, 9-10%, and 11%. In Van Howe's study, all cases of meatal stenosis were among circumcised boys. When the meatus is not covered by the foreskin

Foreskin

In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...

, it can rub against urine soaked diapers resulting in inflammation and mechanical trauma. Meatal stenosis may also be caused by ischemia

Ischemia

In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...

 resulting from damage to the frenular

Frenulum

A frenulum is a small fold of tissue that secures or restricts the motion of a mobile organ in the body.-In human anatomy:...

 artery during circumcision.

In non-circumcised males, meatal stenosis can occur where phimosis

Phimosis

Phimosis , from the Greek phimos ), is a condition where, in men, the foreskin cannot be fully retracted over the glans penis...

 or lichen sclerosus

Lichen sclerosus

Lichen sclerosus is an uncommon disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin....

 is present.

In females, this condition is a congenital

Congenital disorder

A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...

 abnormality which can cause urinary tract infection

Urinary tract infection

A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...

s and bed-wetting

Enuresis

Enuresis refers to an inability to control urination. Use of the term is usually limited to describing individuals old enough to be expected to exercise such control.Types of enuresis include:* Nocturnal enuresis* Diurnal enuresis...

.

Symptoms

• Abnormal strength and direction of urinary stream
• Visible narrow opening at the meatus in boys
• Irritation, scarring or swelling of the meatus in boys
• Discomfort with urination (dysuria
  Dysuria
  In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
  
   and frequency)
• Incontinence
  Urinary incontinence
  Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
  
   (day or night)
• Bleeding (hematuria
  Hematuria
  In medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...
  
  ) at end of urination
• Urinary tract infections - increased susceptibility due to stricture

Signs and tests

In boys, history and physical exam is adequate to make the diagnosis

Medical diagnosis

Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

. In girls, VCUG (voiding cystourethrogram

Voiding cystourethrogram

In urology, a voiding cystourethrogram , also micturating cystourethrogram , is a technique for watching a person's urethra and urinary bladder while the person urinates . The technique consists of catheterizing the person in order to fill the bladder with a radiocontrast agent, typically cystografin...

) is usually diagnostic. Other tests may include:

• Urine analysis
  Urinalysis
  A urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
  
  
• Urine culture
• CBC
  Complete blood count
  A complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
  
  , basic metabolic panel
• Renal and bladder ultrasound
  Ultrasound
  Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
  
  

Treatment

In females, meatal stenosis can usually be treated in the physician's office using local anesthesia

Local anesthesia

Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...

 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

Meatotomy

A meatotomy is a form of penile modification in which the underside of the glans is split. The procedure may be performed by a doctor to alleviate meatal stenosis or urethral stricture...

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.

Prevention

"In a recently circumcised male infant, try to maintain a clean, dry diaper and avoid any exposure of the newly circumcised penis to irritants."

Meir and Livne suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]", while Jayanthi recommends the use of a modified Snodgrass hypospadias repair. Viville states that "prevention is based essentially upon more caution in the use of indwelling urethral catheters."