Clinical presentation and pathophysiology of meatal stenosis following circumcision

Abstract

Objective: To describe the clinical presentation and pathophysiology of meatal stenosis occurring after circumcision.

Patients and methods: The clinical presentation and operative findings are reported in 12 children who presented with meatal stenosis over a period of 3 years.

Results: The cardinal symptoms of meatal stenosis were penile pain at the initiation of micturition (12 of 12), narrow, high velocity stream (8 of 12) and the need to sit or stand back from the toilet bowl to urinate (6 of 12). Following surgical correction with meatotomy there was no recurrence of stenosis after a mean follow-up of 13 months. Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis.

Conclusion: Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.