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Male Meatal Stenosis

more about Male Meatal Stenosis

Stenosis of the urethral meatus in the male

  • The urethra in the male extends between the bladder and the tip of the penis.  Stenosis at the meatus means that there is outlet obstruction at the distal end of the urethra (the very end of the urethra where the urinary opening occurs).
  • This causes lack of a forceful stream, and sometimes pain on urination,
  • Looking at the meatus (the urinary opening), a physician or parent might think that the opening is small and that stenosis is present (that is, an opening so narrow that urine cannot rapidly pass through it).  Many such boys do not develop any symptoms and have no discomfort or voiding difficulty, even though the meatus appears small, because the opening has the ability to stretch when a stream of urine is pressing against it.

  • Occasionally, there is pain while passing urine.  There is lack of a forceful urinary stream.

  • The causes of congenital meatal stenosis are unknown.  A child can also acquire meatal stenosis (scarring of tissue at the meatus) from the irritation of a severe diaper rash.
  • A severe diaper rash can cause a skin ulceration to form at the urinary opening, and this ulcer might heal with a bit of scarring that narrows the urinary opening.
  • It is quite uncommon for a male to be born with meatal stenosis.

  • Watching the patient void is probably the best way to decide if there is a fixed narrowing ( a stenosis ) or not.  One might observe lack of a forceful stream, or a spray of urine to one side, rather than straight ahead.  If this stenosis persists, when the boy stands up to void, the urine does not go into the toilet bowl.
  • It is possible to do X-rays to observe the voiding process, and to look for signs of obstruction
  • Some urologists say that X-rays (a voiding cystourethrogram) are helpful before concluding that meatal stenosis is present, but others feel that watching the urinary stream is sufficient for diagnosis.
  • It is not possible to be certain of the size of the meatus just by measuring it, because it might stretch to a larger caliber as the urine is coming out.

  • Hypospadias (i.e., a deformity of the penis present at birth, in which the urethral meatus is located on the under side of the penile shaft, or underneath the scrotal sac, or opens into the skin area between the scrotum and the anus)
  • A boy with hypospadias is very likely to have congenital meatal stenosis.
  • Circumcision (removal of the foreskin) makes the glans penis and the meatus more exposed to ammonia when the baby sits in his own urine.
  • Alternatively, circumcision makes the exposed glans and the exposed meatus more likely to rub against the diaper and possibly cause a meatal ulcer.

  • If the meatus is too small, the opening can be widened by performing a surgical correction.

  • The narrowed urethral opening could cause urine to backup behind the partial obstruction, just as a beaver dam makes water backup behind it.  This could cause dilation or widening of the entire urinary tract, including the kidneys.
  • This possible complication, though, has hardly ever been seen and is extremely unlikely.
  • The boy with meatal stenosis may be more likely to have bladder infections because urine in the bladder may not completely empty, and stagnating urine gets infected.
  • The only likely complication with meatal stenosis occurs when the boy stands up to pass urine into the toilet, the urine will spray upward or to the sides, causing embarrassment.

  • If the urethral meatus, which is normally a slit, looks quite narrow and small, or there is lack of a forceful stream in the male baby, ask your physician to watch the baby void several times.  This should clarify whether there is lack of a forceful stream, or difficulty starting the stream, or a spray of urine instead of a direct stream.

  • None

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