Sometimes parents notice that their little one has difficulty urinating , or that the urethra does not go straight, but rather protrudes upwards. Sometimes they also say that it hurts when they urinate . It is normal to feel scared when you see something like this. You wonder if this is serious and why this is happening. Today we are going to talk about a condition called 'Meatal Stenosis' that may be the cause of this. Don't worry, let's understand this simply.
What exactly is 'meatal stenosis'?
Simply put, 'meatal stenosis' is a narrowing of the opening at the tip of a boy's penis through which urine comes out (this is what we call the 'meatus' in medical terms). The word 'stenosis' means a narrowing of a passage or tube in our body. So in this condition, what happens is that the opening where urine comes out becomes smaller than normal.
This condition can be present at birth (congenital) or develop later in life. However, it is most common for a child to develop this condition between the ages of 3 and 7 .
Does this happen to adult men too?
Yes, but it is very rare. If an adult develops this condition, it is most likely due to surgery on the urinary tract, the insertion of a device, or some autoimmune disorder.
What are the symptoms of this condition?
The main symptom is that the opening at the tip of the penis is narrowed to the point that it is visible to the naked eye. This narrowing obstructs the flow of urine . This can cause one or more of the symptoms listed below.
| Symptom | A simple explanation |
|---|---|
| Pain or burning when urinating (dysuria) | The child cries or says "it hurts" when urinating . |
| Frequent need to urinate | Urinary urgency occurs more frequently than usual. |
| A thin, rapid urine stream | The urethra is very narrow. Sometimes it leaks very quickly. |
| Urinary incontinence or loss of control | The urethra is not straight, but rather upwards and sideways. It is difficult to aim properly. |
| Bladder not emptying completely | Even after urinating , it feels like there is still urine left. |
| Passing a drop of blood (hematuria) | After you finish urinating , you may see a drop of blood at the tip of your penis. |
What are the causes of 'Metal Stenosis'?
Circumcision has been identified as the main and most common cause of this condition. This condition rarely occurs in an uncircumcised child.
After circumcision, the tip of the penis often rubs against a diaper or the surrounding skin, causing the area to swell and become sore, and the opening may narrow as it heals.
In addition, there may be other reasons.
- Urine -stained diapers: Substances like uric acid and ammonia in urine can accumulate on the diaper and cause inflammation when it comes into contact with the tip of the penis.
- Use of catheters: If you have to have urinary catheters in place for a long time.
- Other surgeries: Surgery or testing that involves inserting an instrument through the urethra.
What happens if it is not treated?
There are different opinions among doctors about this. Some doctors believe that if this condition is left untreated,
- Urinary tract infections (UTIs) can occur.
- Kidneys may be affected.
- Involuntary urination may occur.
However, some other doctors believe that these complications are not only caused by 'meatal stenosis'. Therefore, they recommend surgery not just because the hole is narrow, but only if the aforementioned complications occur.
Therefore, if your child has this condition, it is best to talk to your doctor and decide what is best for him.
How does a doctor recognize this?
A doctor can usually diagnose this condition during a physical examination of the child. During this examination, the following steps are performed:
- Measuring the width of the opening: The doctor will check the width of the opening at the tip of the penis. But remember, not everyone's opening is the same, and your son may have a slightly narrower opening by nature. So the doctor will take all of this into consideration before making a decision.
- Asking questions: You will be asked about things like how the child urinates , where the urine goes, and whether it is leaking.
- Observation: If it's a small child, the doctor may watch the child while they urinate to see if the urinary tract is straight or straining.
- Measuring urinary flow rate: Sometimes, the flow rate of the urine can be measured with a special device.
What are the treatments for this?
There are several treatments for this condition.
1. Meatotomy surgery: This is the best and most successful treatment in most cases. This is a very simple, minor surgery. What is done here is to cut a small part of the narrowed hole and make it larger. This surgery is very successful, and the chance of this condition recurring is very low.
2. Steroid Cream: In some cases, a topical corticosteroid cream applied to the tip of the penis can help treat this condition. This may need to be applied twice a day for about three months.
3. Dilation: Another method is to widen the hole by stretching it with a special device. However, this method can sometimes tear the skin and cause scarring. This method is not used much because the scar tissue can make the hole narrower than before.
What happens after treatment?
After a 'meatotomy', the child will start to feel better within a few days. If there is any pain, painkillers and warm baths can provide relief. Bleeding is usually not present. If there is a little bleeding, pressing the area gently with a clean cloth will stop the bleeding. Applying an ointment recommended by the doctor, such as Vaseline®, twice a day for several weeks will help the wound heal more quickly.
Can this situation be prevented?
There is no way to prevent congenital mitral stenosis.
In most cases, this condition occurs after circumcision, and it can be prevented by not doing so. However, whether or not to get circumcised depends on personal, religious, and cultural beliefs. It is also important to remember that not getting circumcised may slightly increase the risk of other diseases, such as sexually transmitted infections (STIs) and penile cancer.
The best thing to do is to talk to your doctor about this, understand the pros and cons, and make a decision.
If your child is circumcised, regularly applying an ointment recommended by your doctor to the tip of the penis afterward can help prevent this condition to some extent.
When should I see a doctor?
If your child or you have any of the following, see a doctor immediately. Do not stay at home and experiment.
| Opportunity | Description |
|---|---|
| If you have these symptoms, see your doctor. | |
| Difficulty urinating | If the child cannot urinate easily or has difficulty doing so. |
| If you can't urinate at all | Even if there is a heavy flow of urine , not even a little urine comes out. |
| Pain | If you are talking about pain or burning during urination . |
| If these symptoms occur after a meatotomy, go to the ETU immediately. | |
| Fever | If the fever is 38 degrees Celsius (100 Fahrenheit) or higher. |
| Heavy bleeding | If you are bleeding unstoppably. |
| Increased pain | If the pain is getting worse instead of decreasing. |
| Vomiting | If you vomit more than three times a day. |
| Difficulty urinating again | If you still have difficulty urinating after surgery. |
| The diaper is dry. | If a small child has not had a wet nap for several hours (they may be dehydrated). |
Take-Home Message
- 'Metal stenosis' is a narrowing of the opening at the tip of the penis in boys. This is a common condition.
- The main symptoms are urinary incontinence, straining, and pain during urination .
- The most common cause of this is inflammation after circumcision.
- The surgical treatment, called a meatotomy, is very simple, successful, and safe.
- If you notice these symptoms in your child, don't panic. However, be sure to consult a pediatrician or surgeon for advice.
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