Rigi10™ Malleable Penile Prosthesis
Also Known As
Urethral meatal stenosis, Meatal stricture, External urethral stenosis, Urethral outlet obstruction, Pinpoint meatus
Definition
Meatal stenosis is a urological condition characterized by an abnormal narrowing of the urethral opening (meatus) at the tip of the penis, restricting urine flow.1 This structural abnormality can be congenital (present at birth) but is more commonly acquired, particularly as a complication following circumcision.2 The term “stenosis” refers to the pathological narrowing of a passage in the body, in this case affecting the external urethral meatus.3 This narrowing creates increased resistance to urine outflow, leading to altered urinary stream dynamics and associated symptoms. Meatal stenosis occurs in approximately 8-10% of males worldwide, with significantly higher prevalence in circumcised versus uncircumcised individuals.4 The condition typically develops between ages 3-7 when acquired, though it can affect individuals of any age.5 The pathophysiology involves inflammation and subsequent scarring of the meatal tissue, often triggered by exposure to irritants, mechanical trauma, or ischemic changes to the distal urethra.6
Clinical Context
Meatal stenosis is primarily encountered in pediatric urology practice, though it can affect males of any age. The condition is most frequently diagnosed in circumcised males, with studies indicating it is rare in uncircumcised individuals.1 Patient selection criteria for intervention typically include symptomatic presentation rather than anatomical findings alone, as natural variations in meatal width exist.2
The most common etiology in pediatric patients is post-circumcision inflammation, where the newly exposed glans and meatus become irritated by diaper contact or exposure to ammonia and uric acid crystals in urine.3 In adults, meatal stenosis may result from urethral instrumentation, long-term catheterization, lichen sclerosus, or other inflammatory conditions affecting the distal urethra.4
Clinical presentation typically includes an upward-deflected, difficult-to-aim urinary stream, dysuria (painful urination), urinary frequency, urgency, and occasionally terminal hematuria (blood at the end of urination).5 Physical examination reveals a pinpoint or narrowed meatal opening, and observation of urination often demonstrates a thin, sometimes forceful stream with incomplete bladder emptying.6
Diagnostic evaluation is primarily clinical, though urinalysis may be performed to rule out infection. In cases with more complex presentation, additional studies such as uroflowmetry or ultrasound may be indicated to assess for upper urinary tract complications.2
Treatment options include:
1. Surgical meatotomy/meatoplasty: The mainstay of treatment, involving surgical widening of the meatal opening. This outpatient procedure has a high success rate with low recurrence.3
2. Topical corticosteroid therapy: In milder cases, application of steroid cream to the meatus twice daily for up to three months may provide sufficient relief.4
3. Meatal dilation: Less commonly employed due to risk of scarring and lower success rates compared to surgical approaches.5
Expected outcomes following appropriate intervention are excellent, with most patients experiencing complete resolution of symptoms and normal urinary function.6 Without treatment, potential complications include urinary tract infections, incomplete bladder emptying, and rarely, upper urinary tract damage from chronic obstruction.1