Meatoplasty/Meatotomy

What is a meatoplasty?

Meatoplasty is a type of surgery to enlarge the urethral meatus at the end of the penis. The urethral meatus is the opening at the tip of the penis (glans), at the end of the urethra, where pee (urine) leaves your body.

What is the difference between a meatoplasty and a meatotomy?

A meatoplasty and a meatotomy are very similar procedures. During a meatoplasty, a surgeon cuts open the tip of the penis and remodels the meatus. They may also stitch the edges.

A meatotomy isn’t as complex of a procedure — they widen the meatus but may not reconstruct the tissue or use stitches. Many people use these terms interchangeably.

What does a meatoplasty treat?

A meatoplasty treats meatal stenosis. Meatal stenosis is when the urethral meatus is too narrow. It’s a congenital (present at birth) condition but can also develop later in a child’s life, usually between the ages of 3 and 7. It almost exclusively occurs in circumcised children. A narrow urethral meatus causes symptoms like:

• Trouble aiming the pee stream.
• A pee stream that’s narrow, fast or exits the urethra in an upward or sideways direction.
• Pee that sprays in different directions.
• Peeing more than expected.
• Pain or a burning sensation while peeing.

Healthcare providers may also perform a meatoplasty on babies who have a mild form of hypospadias. Hypospadias is a congenital condition (a condition that’s present at birth) in which the urethral meatus doesn’t form at the tip of the penis — it may form on the shaft of the penis or elsewhere.

What causes meatal stenosis?

Irritation that leads to scarring causes meatal stenosis. This may include:

• Surgery to remove the foreskin from the penis (circumcision).
• The friction that occurs when your baby’s penis rubs against a diaper.
• Using urinary catheters for a long time.

How should I prepare my child for meatoplasty?

You’ll first take your child to their healthcare provider before a meatoplasty. They’ll go over your child’s general health and take their vital signs. They’ll also perform a physical examination of your child’s penis, which may include:

• Examining your child’s meatus, including measuring its width.
• Asking you questions, including in which direction their pee flows or if there’s any spraying.
• Observing your child while they pee to see if their stream is straight.
• Measuring the strength of their pee stream (flow rate).

Your child’s provider will ask if your child has any history of bleeding disorders. You should also tell them if your child is taking any prescription or over-the-counter medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), certain herbal supplements and other medications can increase your child’s risk of bleeding during a meatoplasty.

Also, tell the provider if your child has any allergies, including:

• Medication allergies.
• Latex allergy.
• Food allergies.
• Skin cleaner (iodine or isopropyl alcohol) allergies.

Your child’s provider will also explain the procedure to you. Understanding what the procedure involves and being able to ask them questions can help you remain calm before surgery, which can help your child relax.

The provider may suggest paying more attention to your tone of voice and facial expressions. It’s also a good idea to read your child their favorite book or let them play with their favorite toys before surgery. Your child may not have the vocabulary or ability to understand what’s happening. But they can pick up on your body language. When you’re calm, your child may feel more relaxed.

Who makes up my child’s meatoplasty team?

Your child’s surgical team will generally include:

• Pediatric urologist. A pediatric urologist is a surgeon who specializes in diagnosing and treating conditions that affect children’s urinary and reproductive
• Pediatric anesthesiologist. A pediatric anesthesiologist is a type of doctor who specializes in giving children anesthesia. Anesthesia reduces pain during medical procedures or surgery.
• Surgical nurses. Surgical nurses help care for your child before, during and after surgery. They may also assist the surgeon during the meatoplasty.

How is a meatoplasty performed?

Shortly before the meatoplasty, a healthcare provider will sanitize your child’s penis with a skin cleaner and apply a numbing cream. The pediatric anesthesiologist will then give your child anesthesia so they sleep through the procedure and won’t feel any pain.

Once your child is asleep, the pediatric urologist will:

• Pass a soft tube into the meatus to measure it.
• Make a V-shaped cut on the bottom of the penis, below the meatus, to enlarge the opening.
• Use surgical glue or, if necessary, stitches (sutures) to bring the tissue back together and promote healing.
• Check for other narrow areas of the meatus.
• If necessary, insert a urinary catheter to help your child pee.

If your child can tolerate it, a provider may try to perform a meatotomy in an office setting without general anesthesia. They’ll apply a numbing cream and leave it on your child’s penis for 30 to 60 minutes. They’ll clamp the tissue and make a cut to enlarge the opening. They won’t use any stitches after the procedure.

How long does a meatoplasty take?

A meatoplasty usually takes less than an hour to complete.

Is it painful to have a meatotomy?

A meatotomy can be bothersome. Some stinging or burning when your child pees is normal, and it can last for a week or two. It’s also normal to see a small amount of bloody drainage.

What happens after a meatoplasty?

After a meatoplasty, the anesthesiologist will stop putting anesthesia into your child’s body. Nurses will move your child to a recovery room, where they’ll wait for them to wake up and monitor their overall health. A meatoplasty is usually an outpatient procedure, so your child can go home the same day they have surgery. If your child has a meatoplasty to treat severe meatal stenosis, they may have to stay in a hospital for a few days as they recover.

Healthcare providers will give you instructions on how to help your child recover after a meatoplasty, especially during their first week of recovery. They may prescribe your child medication to help relieve pain.

What are the benefits of a meatoplasty?

Meatoplasty benefits include:

• Increasing the size of the urethral meatus.
• Reducing peeing problems, including trouble aiming and spraying.

How successful is a meatoplasty?

The success rate for a meatoplasty is good. It’s a safe, common surgery, and the overall outlook for children who have the procedure is excellent. There are rarely any complications after healing, and there’s seldom any need for follow-up treatment.

At what age should my child have a meatoplasty?

Healthcare providers may recommend a meatoplasty for children as young as 3 months old.

What are the risks of a meatotomy?

Though a meatotomy is a generally safe procedure, all surgeries have some risks. Meatotomy risks may include:

• Bleeding.
• Irritation.
• Inflammation.
• Bacterial infection.
• Scarring.
• Blood clots.
• Anesthesia complications, including fatigue, headache, nausea and vomiting and difficulty peeing.
• Spraying while peeing until the area heals.
• Stinging or burning while peeing.

How long does a meatoplasty take to heal?

Your child’s body is unique, so recovery times may vary. In general, most children should start to feel better within a week. They may spend the first few days after a meatoplasty sleeping more. Sleep is good because it helps them recover faster.

Your child should take it easy for at least a week after a meatoplasty. Don’t let them play with straddling toys like a bicycle, rocking horse, swing or see-saw. Avoiding sports or other physical play during this time is also a good idea.

How do I care for my child after a meatotomy?

Managing your child’s pain generally includes:

• Acetaminophen suspension (Tylenol Children’s®).
• Ibuprofen suspension (Advil Children’s®).
• Applying an antibiotic ointment (Aquaphor® or Neosporin®) or petroleum jelly (Vaseline®) at least three times a day.

Avoid giving your child aspirin (Bayer Children’s Aspirin®). Aspirin may increase your child’s risk of bleeding.

It’s important to keep your child’s penis as clean as possible. Wash your hands with soap and water before changing your child’s bandages.

Dress your child in loose-fitting underwear, if possible. If your child still wears diapers, change them regularly. It’s a good idea to avoid wearing diapers for a few hours each day.

Gently bathe your child with warm water and soap. But be careful around their penis, and gently pat the area dry.

When can my child go back to daycare or school?

Keep your child home from daycare or school for at least a week.

When should I call a healthcare provider?

Schedule regular follow-up appointments with your child’s healthcare provider. They’ll make sure your child’s penis is healing as expected.

When should I take my child to an emergency room after a meatoplasty?

Take your child to the nearest ER right away if they have any complications or abnormal symptoms after a meatoplasty. These may include:

• A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher.
• Heavy bleeding.
• Increased pain.
• Vomiting three or more times a day.
• Difficulty peeing.
• Your child’s diaper is regularly dry.

Can an adult get a meatoplasty?

Yes, an adult can get a meatoplasty, though it’s rarer. In adults, the urethral meatus may narrow after surgery on the urethra or in other areas near the meatus. It can also develop after long-term use of a urinary catheter.