Meatal Stenosis

Overview

What is meatal stenosis?

Meatal stenosis is a condition where the meatus — the opening of at the tip of the penis — becomes narrower. The word “stenosis” means that a passage in your body is narrower than normal. This condition can be there at birth or it can happen later in life. If you develop meatal stenosis, it usually happens between the ages of 3 and 7.

How common is meatal stenosis?

One study has found that about 9% of boys have meatal stenosis at birth. In a follow-up study of 1,800 boys aged 6 to 10 years, visual inspection found 32% had a “pinhole” meatus. This implies that about 23% of all cases happened after birth.

Symptoms and Causes

What causes meatal stenosis?

Meatal stenosis happens when the opening at the end of the penis narrows. This condition is almost always seen in males who have been circumcised. Circumcision is a procedure where the foreskin over the head of the penis is removed. It’s rare for uncircumcised males to have meatal stenosis. This could mean that circumcision is a possible reason the meatus became narrower. Other causes of meatal stenosis can include:

  • Inflammation (swelling) or injury that results from a baby’s penis rubbing against a diaper or the baby’s own skin after circumcision.
  • A diaper containing the buildup of crystals of uric acid and ammonia, which are found in urine.
  • Long-term use of urinary catheters (tubes used to drain urine).
  • Procedures or surgeries involving insertion of instruments into the urethra.

What are the symptoms of meatal stenosis?

The symptoms of meatal stenosis happen as a result of urine flow becoming partly blocked.

If this happens, you could experience symptoms like:

  • Pain or burning while urinating.
  • Sudden urges to urinate.
  • Having to urinate often.
  • A small, narrow, very fast urinary stream.
  • A urinary flow that sprays (usually upward) or is difficult to aim.
  • Trouble with fully emptying your bladder.
  • A drop of blood at the tip of the penis after urinating.

Diagnosis and Tests

How is meatal stenosis diagnosed?

Diagnosis of meatal stenosis typically starts with your healthcare provider doing a physical exam and measuring the width of the meatus . A small, narrow meatus means that the passage is partly blocked.

However, there are natural differences in meatal widths in different males. This means that you could naturally have a narrow meatus without having meatal stenosis.

There are also other factors that your healthcare provider will consider during the diagnosis process. Your overall health — not just the appearance of the meatus — is the key to deciding whether stenosis is present or not. Observation during urination can determine whether your urine stream is straight or not. Also, your healthcare provider can take measurements of the rate of flow that can help make the right diagnosis. An uncontrolled path of a urine stream and spraying of the urinary stream could mean that a correction of the meatal stenosis is needed.

Management and Treatment

How is meatal stenosis treated?

There are several ways to treat meatal stenosis. In some cases, a steroid cream may be applied to the meatus. However, in most cases, a procedure called meatotomy is the best treatment. This procedure involves cutting apart the stuck part of the meatus so that the opening is made bigger. After this procedure, it’s rare for the meatal stenosis to come back.

One other possible treatment option is to try to stretch the opening of the meatus wider. However, this treatment has the possible side effect of tearing the skin, which could lead to the formation of scar tissue that would make the opening even narrower.

What can I expect after treatment for meatal stenosis?

After surgery to repair meatal stenosis (meatotomy), pain relievers and warm baths may be taken to reduce discomfort. Bleeding is not common. If you do experience bleeding, it can usually be controlled by holding pressure on the affected area.

Recovery time is about one to two days. However, spreading petroleum jelly or an ointment on the surgical area several times a day for one to two weeks can help the wound heal faster.

What are possible complications of untreated meatal stenosis?

There’s a wide variety of opinion in the medical community about what happens to the urinary system if you don’t treat meatal stenosis. Some researchers believe that the condition can lead to complications like:

Other medical researchers doubt that these medical conditions can result from stenosis alone and they recommend only performing meatotomy if symptoms are present — not just based on the appearance of the meatus.

Prevention

How can meatal stenosis be prevented?

There’s no way to prevent meatal stenosis that’s present at birth.

Choosing to leave the penis uncircumcised would eliminate most cases of meatal stenosis. Not circumcising may slightly raise the risks of other health problems such as urinary tract infections in infant boys, some sexually transmitted diseases in men and penile cancer (which is very rare and is preventable by routine vaccinations).

Applying Vaseline regularly after circumcision might prevent meatal stenosis from occurring.

A note from Cleveland Clinic

Although meatal stenosis can be present at birth, it’s often linked to circumcision. Not circumcising your child can help prevent meatal stenosis. There are pluses and minuses to circumcision, and the decision to circumcise your child generally depends on your personal, religious and cultural beliefs. Talk to your healthcare provider about all of the risks and benefits of circumcision.

Last reviewed by a Cleveland Clinic medical professional on 12/29/2020.

References

  • Urology Care Foundation. What is meatal stenosis? (http://www.urologyhealth.org/urologic-conditions/meatal-stenosis) Accessed 12/30/2020.
  • Morris B, Krieger J. Does Circumcision Increase Meatal Stenosis Risk? — A Systematic Review and Meta-analysis. (https://pubmed.ncbi.nlm.nih.gov/28826876/) Urology. Dec 2017; 110: 16-26. Epub Aug 2017. Accessed 12/30/2020.
  • Belman AB, Filmer BB, Immergut MA, Schoenberg HW. Uretal Meatal Stenosis in Males (http://pediatrics.aappublications.org/content/61/5/778) Pediatrics, May 1978, Vol. 61 Issue 5. Accessed 12/30/2020.
  • Persad R, Sharma S, McTavish J, Imber C, Mouriquand PD. Clinical presentation and pathophysiology of meatal stenosis following circumcision (http://www.cirp.org/library/complications/persad/) British Journal of Urology, Vol. 75, No. 1: 91-93, Jan. 1995. Accessed 12/30/2020.
  • American Academy of Family Physicians, familydoctor.org. Circumcision. (https://familydoctor.org/circumcision/) Accessed 12/30/2020.

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