Meatotomy is a surgical procedure used to treat strictures of the external urethral orifice. The surgeon slits the external urethral orifice and sutures it back together in dilated anatomy. Meatotomy causes discomfort during urination for the first week after surgery.
What is meatotomy?
Meatotomy is a surgical procedure used to treat narrowing of the external urethral orifice. Meatus stenosis is the term used to describe a narrowing of the urethral orifice. Such narrowing is in many cases congenital, but it can also be acquired and is then associated with injury or inflammation in the area. Meatus stenosis is a painful condition and causes pain especially during urination. In addition, the narrowing can promote the colonization of bacteria and thus infections of the urinary tract. In addition, a narrowing in the area of the external urethral orifice can result in a weakening of the urinary stream or incomplete emptying of the bladder. Incomplete bladder emptying in particular is associated with recurrent bladder infections. In order to prevent such phenomena, prompt treatment of the primary cause is indicated. Various procedures are available for the treatment of meatus stenosis. One of them is meatotomy. This is a surgical widening in the area of the external urethral orifice, which is used primarily for short-stretch stenosis. Meatotomies are surgical procedures and thus are considered invasive treatment procedures.
Function, effect, and goals
A meatotomy is performed on the indication of a narrowed urethral orifice. In most cases, it is an outpatient surgery performed under local anesthesia and usually takes no more than ten minutes. In special cases, general anesthesia is used, especially on children, cooperative patients or people with an unstable psyche. During the operation, the doctor slits the narrowing in the area of the external urethral orifice. After slitting, the doctor sutures the slit area. He proceeds in such a way that the urethra remains as wide as possible. At the end of the surgical procedure, the patient usually has a catheter inserted into the urethral orifice. This catheter is intended to stabilize the dilation on the one hand, and on the other hand to ensure that the urine can flow out without pain despite the sore urethral orifice and is passed over the wound. In addition, the catheter prevents the dilated orifice from becoming stuck and the urethra from growing together in a stuck position. In most cases, the catheter remains in the orifice for only the first 24 hours. After about a week, the wound is healed. One day after the operation, the catheter is removed. Slitting of the external urethra is not suitable for all meatus stenoses. In some cases, for example, the symptoms are caused by tumors, which require a completely different treatment. Meatotomy is also not indicated in cases of higher-grade or complicated urinary meatus stenosis. In these cases, reconstruction of the urethral orifice, also known as meatusplasty, is more likely to be performed. The meatotomy described here is the plastic meatotomy. Plastic slitting of the external urethral orifice should be distinguished from Otis meatotomy. In this procedure, two different sites are slit at the urethral orifice with a special instrument. Compared to plastic meatotomy, Otis meatotomy causes more pain and shows a slightly higher risk of recurrence. Although recurrences are not excluded even with plastic meatotomy, the procedure is sometimes the most commonly used surgical procedure for meatus stenosis and is sometimes judged to have the greatest chance of success.
Risks, side effects, and hazards
Meatotomy is an operation and, as such, is associated with various risks and side effects for the patient. These include, for example, general surgical risks. These surgical risks are, for example, bleeding or infection. However, today’s medicine is able to keep the risk of infection in particular to a minimum due to modern standards. If general anesthesia is used, the high stress on the cardiovascular system caused by the operation must be taken into account.As a rule, a healthy person can cope with this stress. However, in extreme cases, the stress can lead to circulatory collapse or even cardiac arrest. Reactions to the anesthetic are more common. These reactions include, for example, nausea, headache or vomiting. Meatotomy is associated with some surgery-specific risks and discomfort in addition to general surgical risks. For example, some patients fear the risk of incontinence. However, it is virtually impossible for incontinence to result from a meatotomy. However, if a catheter is not inserted, adhesion of the wound may result. In this case, the surgical area must be partially reopened in order to exclude the possibility of faulty adhesion of the urethral orifice. In the first week after surgery, meatotomy patients also often feel a sensation of pressure in the operated area. In addition, there are unpleasant sensations during urination. For example, many sufferers report a burning sensation until the wound has completely healed. There may also be risks associated with healing. As a rule, scarring is kept within limits with a professionally performed meatotomy. In individual cases, however, excessive formation of scar tissue has been observed. This phenomenon can lead to repeated stenosis of the external urethral orifice and requires further surgery. As a rule, a meatotomy is not performed again after such a prolapse. Rather, the decision is made to reconstruct the external urethral orifice after a recurrence.
