AUA Summit - What is Meatal Stenosis?

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What is Meatal Stenosis?

Meatal stenosis is when the opening at the end of the penis becomes narrow. This condition is usually acquired but can exist from birth.

Sometimes the opening of the penis where urine passes can become blocked. This can cause problems with passing urine. This article should help you understand this condition and how it can be treated.

How Does the Penis Normally Work?

The main roles of the penis are to carry urine and sperm out of the body. The urethra is the tube that carries urine and sperm through the penis to the outside. The opening to the outside is called the "meatus."

Symptoms

The symptoms of meatal stenosis relate to the stream of urine being partly blocked.

These can include:

  • A urinary stream that sprays or is deflected (not in a straight direction)
  • Pain or burning while passing urine
  • Getting sudden urges to pass urine ("urgency")
  • Needing to pass urine often ("frequency")
  • A small drop of blood at the tip of the penis when finished passing urine

Causes

Meatal stenosis is mostly linked with circumcision and is rarely seen in uncircumcised males. It’s likely that the newly exposed tip of the penis (including the meatus) suffers from irritation causing meatus to narrow (stenosis). Uric acid and ammonia crystals are the most common cause for the narrowing of the meatus. These crystals are found in the urine and can be left in the diaper before your baby is changed. These crystals may cause a low grade inflammation which can cause the meatus to narrow over time.

Meatal stenosis can also result from mild ischemia (not enough blood to that part of the body) that occurs during circumcision. Finally, it can also be caused by a mild injury to the tip of the penis as it rubs against the diaper or the child’s own skin after circumcision.

Meatal stenosis can also occur after hypospadias repair. While this isn’t common, it’s seen in up to 1 in 25 patients who have this surgery.

The risk of meatal stenosis is also higher with:

  • Injury to the penis tip
  • Inflammatory skin conditions (including balanitis and BXO)
  • Long-time use of urinary catheters (tubes)

Diagnosis

Meatal stenosis is found by your health care provider with a physical exam. A physical exam will show a small, narrowed meatus. This means the pathway is partly blocked. The lower part of the meatus is often stuck together. There’s no need to measure the opening, as that could cause more harm.

Treatment

The best way to treat meatal stenosis is with surgery. The stuck bottom part of the meatus is cut apart. This type of surgery is called a “meatotomy.” After surgery, meatal stenosis rarely comes back as long as proper care is taken. This can be done in the doctor’s office with a numbing cream applied to the penis or can also be done under anesthesia.

Meatal stenosis can also be treated by stretching the opening wider (“dilation”), but this can tear the meatus. While this may relieve symptoms for a while, it can cause more scars to form. The new scars may make the meatus narrower and cause worse symptoms.

After Treatment

Meatotomy works very well. Pain at the tip of the penis can be helped with oral pain killers or warm baths. Bleeding is rare and usually controlled with direct pressure. Recovery time is fast: typically 1 to 2 days. Spreading lubricating ointment or petroleum jelly on the tip of the penis several times a day for 1 to 2 weeks can ease discomfort and help the wound to heal without the narrowing coming back.

Updated March 2024. 


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