Meatal stenosis

Meatus is the opening of the urethra, the tube through which urine comes out of the body. A narrowing of this opening is called meatal stenosis. 

The condition can occur in both females and males. It is usually congenital in females, though can occur later in life too. However, females rarely get this condition, partly due to the short size of their urethra. Meatal stenosis is more common in males, especially those who are circumcised. The condition may not be detected until a child is toilet-trained. (Read more: Male circumcision)

The symptoms of meatal stenosis usually are noticed when a child starts using the toilet. Here are some of the symptoms of the condition:

• Painful and frequent urination
• Abnormal direction of pee (upwards)
• Difficulty passing urine and emptying the bladder
• Narrow stream of urine
• Hematuria (blood in urine)
• Bedwetting
• Sprays of urine instead of a single stream

Meatal stenosis is congenital in women. In adult women, it can occur due to recurrent vaginitis or a lot of cystoscopy procedures. 

In males, the condition occurs due to swelling, inflammation and formation of scar tissue due to circumcision. However, it can also occur due to:

• Inflammation in the penis that occurs due to diaper use in circumcised babies.
• Rubbing against uric acid or ammonia crystals that are left in the diaper when the child urinates.
• Use of a urinary catheter, which is a tube that is inserted into the bladder to drain urine.
• The after-effect of a surgery involving the urethra.
• After a procedure to treat prostate enlargement.

Meatal stenosis is also common in people who have surgery to correct hypospadias, which is a congenital condition in which the urethral opening is present on the ventral or underside of the penis instead of on the tip.

Meatal stenosis that is present since birth cannot be prevented. 

However, you can take the following steps to prevent meatal stenosis due to circumcision:

• Make sure that the circumcised penis does not come in contact with irritants.
• The baby's diaper should always be clean and dry.
• Instead of traditional circumcision, you can go for a procedure called preputial plasty to remove the foreskin. The procedure is less invasive and hence is less likely to injure the penis.

Meatal stenosis is diagnosed through a physical examination and from the presence of symptoms. However, the doctor may also order certain tests including:

• Urinalysis
• Urine culture
• Kidney and bladder ultrasound

In females, the condition may be diagnosed with a voiding cystourethrogram, which is an imaging test to check the bladder and urethra.

Surgery is the best option to treat meatal stenosis in males. A procedure called meatotomy or meatoplasty is used to increase the size of the meatus and relieve the symptoms. The surgery can be done both as an outpatient procedure or in the operating room.

However, in females, the doctor may just use an instrument to dilate the opening of the urethra. The same can also be done in boys. However, dilation may tear the meatus and lead to scar formation and worsening of the condition.

When left untreated, meatal stenosis can lead to the following complications:

• Urinary incontinence
• Difficulty urinating
• Urinary tract infections
• Hematuria
• Swelling or damage to the kidney or the bladder