Meatal stenosis

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Urethral meatal stenosis
Other namesUrethral stricture
SpecialtyUrology

Urethral meatal stenosis is a narrowing (stenosis) of the opening of the urethra at the external meatus /miːˈeɪtəs/, thus constricting the opening through which urine leaves the body from the urinary bladder.

Symptoms and signs

  • Visible narrow opening at the meatus in boys
  • Irritation, scarring or swelling of the meatus in boys
  • Abnormal strength and direction of urinary stream
  • Discomfort with urination (dysuria and frequency)
  • Incontinence (day or night)
  • Bleeding (hematuria) at end of urination
  • Urinary tract infections - increased susceptibility due to stricture

Causes

In the absence of the foreskin the meatus is exposed to mechanical and chemical irritation from ammoniacal diaper (nappy) that produces blister formation and ulceration of the urethral opening, which eventually gives rise to meatal stenosis (a narrowing of the opening).[1] Meatal stenosis may also possibly be caused by ischemia resulting from damage to the frenular artery during circumcision.[1][2]

Risk factors

Risk factors for meatal stenosis include:

Circumcision[3]

Hypospadias repair[4]

Balanitis xerotica obliterans (BXO)[3]

Long-term urinary catheter usage[5]

Trauma to the penis[3]

Diagnosis

In males, history and physical exam are used to make the diagnosis. In females, VCUG (voiding cystourethrogram) is usually diagnostic. Kidney function studies, urine flow rate, evidence of urinary tract blockage, and other physiological measurements should be taken into account when making a diagnosis, rather than just visual inspection.[6] Other tests may include:

Prevention

In the newborn

A meta-analysis of 3 trials found that petroleum jelly significantly reduces the risk of meatal stenosis in newly circumcised infants.[7] MedlinePlus recommends keeping the diaper clean and to avoid exposing the newborn's penis to any irritants after circumcision.[8]

After hypospadias repair

Meir & Livne (2004) suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]",[4] while Jayanthi (2003) recommends the use of a modified Snodgrass hypospadias repair.[9]

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 males, it is treated by a second surgical procedure called meatotomy in which the meatus is crushed with a straight mosquito hemostat and then divided with fine-tipped scissors.[3]

Prognosis

Most people can expect normal urination after treatment.[3]

Incidence

Although circumcision is believed to be a primary factor, reported incidence of meatal stricture among circumcised males is uncertain. Emedicine (2016) stated that meatal stenosis rates in some studies run anywhere from 9 to 20 percent, while noting that these estimates are difficult to fully ascertain.[3] Sörensen & Sörensen (1988), Cathcart et al. (2006), and Simforoosh et al. (2010) reported 0 percent,[10] 0.55 percent,[11] and 0.55 percent respectively.[12] Van Howe (2006) reported an incidence of 7.29 percent[2] and Frisch & Simonsen (2016) placed the incidence at 5 to 20 percent of circumcised boys.[1]

A 2017 meta-analysis of 27 studies covering 1.4 million men concluded that that the rate of meatal stenosis in circumcised males (0.66%) was not statistically different than the rate found in uncircumcised males.[7]

References

  1. Frisch M, Simonsen J (April 2018). "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". The Surgeon. 16 (2): 107–118. doi:10.1016/j.surge.2016.11.002. PMID 28017691. Published online ahead of print on 22 December 2016.
  2. Van Howe RS (2006). "Incidence of meatal stenosis following neonatal circumcision in a primary care setting". Clinical Pediatrics. 45 (1): 49–54. doi:10.1177/000992280604500108. PMID 16429216.
  3. Koenig JF (22 September 2016). "Meatal stenosis". EMedicine. Retrieved 21 August 2017.
  4. Meir DB, Livne PM (June 2004). "Is prophylactic antimicrobial treatment necessary after hypospadias repair?". The Journal of Urology. 171 (6 Pt 2): 2621–2. doi:10.1097/01.ju.0000124007.55430.d3. PMID 15118434.
  5. Cleveland Clinic (March 27, 2024). "Meatal Stenosis". Cleveland Clinic. Retrieved October 14, 2026.
  6. Morris, B. J., Moreton, S., & Krieger, J. N. (2018). Meatal stenosis: getting the diagnosis right. Research and Reports in Urology, 10, 237–239. https://doi.org/10.2147/RRU.S192310
  7. Morris, Brian J.; Krieger, John N. (December 2017). "Does Circumcision Increase Meatal Stenosis Risk?-A Systematic Review and Meta-analysis". Urology. 110: 16–26. doi:10.1016/j.urology.2017.07.027. ISSN 1527-9995. PMID 28826876.
  8. "Meatal stenosis: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2026-10-18.
  9. Jayanthi VR (October 2003). "The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis". The Journal of Urology. 170 (4 Pt 2): 1603–5, discussion 1605. doi:10.1097/01.ju.0000085260.52825.73. PMID 14501672.
  10. Sörensen SM, Sörensen MR (1988). "Circumcision with the Plastibell device. A long-term follow-up". International Urology and Nephrology. 20 (2): 159–66. doi:10.1007/BF02550667. PMID 3384610. S2CID 29147788.
  11. Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE (July 2006). "Trends in paediatric circumcision and its complications in England between 1997 and 2003". The British Journal of Surgery. 93 (7): 885–90. doi:10.1002/bjs.5369. PMID 16673355. S2CID 42869269.
  12. Simforoosh, Nasser; Tabibi, Ali; Khalili, Seyed Ali Reza; Soltani, Mohammad Hossein; Afjehi, Abolfazl; Aalami, Fatemeh; Bodoohi, Heshmat (June 2012). "Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell". Journal of Pediatric Urology. 8 (3): 320–323. doi:10.1016/j.jpurol.2010.10.008.