Meatus Stenosis: Causes, Symptoms & Treatment

Meatus stenosis is a narrowing of the urethral orifice. It is either congenital or occurs due to injury or inflammation.

What is meatus stenosis?

Meatus stenosis is a narrowing of the orifice of the urethra. Like the urethral valve, meatus stenosis is an infravesical obstruction. Congenital narrowing of the urethral orifice often becomes apparent in childhood. It is more often seen in the male gender, which is due to their longer urethra. The urethral orifice is part of the human urethra, whose function in both men and women is to expel urine. Urine collects inside the urinary bladder and from there it enters the urethra, where it is excreted from the body. However, narrowing of the urethra or urethral orifice can cause interference with this function.

Causes

The causes of meatus stenosis vary. For example, the narrowing of the urethra may have existed since birth. However, inflammations such as meatitis or balanitis, injuries, or tumors of a benign or malignant nature can also be considered as causes of the stenosis. In addition, meatus stenosis is a complication of penile foreskin circumcision. Thus, the incidence is reported to be nine to eleven percent. Since the narrowing of the urethral orifice restricts the quality of life of those affected, rapid medical treatment is advised. It is not always possible to find a specific cause for the narrowing of the urethra, which is particularly true for patients under 45 years of age. In older sufferers, surgical procedures are primarily responsible for subsequent meatus stenosis.

Symptoms, complaints, and signs

A typical symptom of meatus stenosis is the weakening of the urinary stream. This also appears split or twisted in some cases. Furthermore, affected individuals suffer from frequent urination as well as pain during urination. If the bladder cannot be emptied regularly, there is a risk of further sequelae such as repeated urinary tract infections. In males, narrowing of the urethral orifice is often accompanied by hypospadias. In this case, the opening of the urethra shifts to the lower side of the penis. If meatus stenosis occurs in the female sex, this is noticeable, among other things, by repeated urinary tract infections. In addition, micturition is difficult. Other possible complaints are enuresis (wetting) and the formation of residual urine. In some people, urethral stricture can also result in complete urethral blockage. In such cases, patients suffer considerable pain. Even a buildup of urine up to the kidneys is conceivable. If this kidney congestion is not treated, there is a risk of life-threatening complications. In men, there is also a risk of scarring of the erectile tissue. Doctors then speak of spongiofibrosis, which in turn results in erectile dysfunction.

Diagnosis and course of the disease

If meatus stenosis is suspected, it is recommended to consult a urologist who specializes in the treatment of urinary tract disease. The latter will perform a physical examination of the patient. It is not uncommon for the doctor to be able to identify the stenosis with the naked eye. Another examination method is urethral calibration. In this procedure, the physician gently inserts metal or plastic rods of various diameters into the urethra. In this way, the extent of meatus stenosis can be determined. If the opening is too small, a smaller surgical procedure is usually required. The urodynamic relevance can be clarified by measuring the urinary stream. In order to exclude tumors in the urethra, it is recommended to perform a urethroscopy. If meatus stenosis is not treated, there is a risk of urinary retention and renal dysfunction, which has a negative impact on the patient’s quality of life. However, there is a risk of recurrence even if therapy is successful.

Complications

In most cases of meatus stenosis, affected individuals suffer from a severely reduced urinary flow. This may also cause pain during urination, which significantly reduces the patient’s quality of life.Furthermore, the pain can also be burning and thus not infrequently leads to depression or other psychological complaints. Sometimes those affected are not infrequently ashamed of the complaints and suffer from inferiority complexes. Furthermore, infections of the urinary tract can occur, which are also associated with severe pain. Kidney congestion can also occur as a result of meatus stenosis, leading to dangerous symptoms. In the worst case it comes thereby to a kidney insufficiency, which can lead untreated to the death. #

Erectile dysfunction can also occur due to meatus stenosis and lead to tension with the partner or likewise to depressive behavior. The patient’s quality of life is significantly reduced and limited by this disease. The treatment of meatus stenosis takes place through surgical intervention. As a rule, there are no complications. However, various disturbances can occur during wound healing, so that the affected person may be dependent on taking antibiotics. Life expectancy is usually not limited with successful treatment.

When should you see a doctor?

A permanently decreased urinary stream is already a sign of an existing health disorder. It should be examined by a doctor so that a diagnosis and subsequent treatment can be made as soon as possible. If the affected person suffers from a frequent urge to urinate, which often occurs immediately after going to the toilet, a doctor should be consulted. Pain during urination and the inability to empty the bladder completely should be clarified by a doctor. A backlog of urine leads to complications and can trigger further illnesses. If it is noticed, it is therefore advisable to consult a doctor. There is a health impairment that must be treated immediately to prevent kidney dysfunction. If the situation continues to deteriorate, there is a risk of organ damage or failure of kidney function. Recurrent infections of the urinary tract or bladder should be clarified in consultation with the attending physician. If men suffer from a narrowing of the urethra, this should also be discussed with a doctor. In the event of nocturnal enuresis, sleep disturbances or a general feeling of malaise, a visit to the doctor should be made. If pain occurs in the abdomen and increases in intensity, a visit to the doctor is necessary.

Treatment and therapy

Treatment of meatus stenosis is basically with surgery. Thus, other therapeutic measures have so far proved ineffective. Meatotomy (urethral slitting) is considered the surgical method of first choice. In this procedure, in which the patient is given a general anesthetic, the urethral opening is widened. During this procedure, the surgeon inserts a special instrument equipped with a small knife into the opening. The knife slits the constriction so that unobstructed flow of urine can take place again. It is not necessary to suture the small wound, as it heals on its own. To ensure that the healing process is undisturbed, the patient is temporarily given a catheter to drain the urine. The meatotomy is not complicated. It takes only a few minutes and is usually performed on an outpatient basis. Possible surgical risks, such as wound healing disorders or injuries, occur only rarely. If the meatus stenosis is pronounced or complicated, a meatoplasty is usually performed. In this surgical method, the opening of the urethra is completely reconstructed. Surgical intervention is performed when the patient suffers from discomfort during urination. If there is urinary retention, the operation must be performed in any case. For the follow-up treatment of the meatus stenosis some control examinations are still necessary. Surgery cannot be performed if general anesthesia poses too great a risk to the patient, which may be the case especially in children.

Outlook and prognosis

The prognosis for meatus stenosis is favorable. Regardless of whether the disorder is congenital or develops during life, there are good treatment options that lead to cure of the disease. What is mandatory is surgical intervention. Although this is associated with risks and the possibility of complications, it is a routine procedure that is usually trouble-free.Under optimal conditions, the patient can be discharged from treatment as recovered within a short time. A return of symptoms does not normally occur. A stable state of health of the patient and good wound healing are important for a trouble-free course of the procedure. Since the patient is placed under general anesthesia, there should be no other pre-existing conditions or a weakened immune system. If these risk factors can be excluded, the prognosis is very favorable. This outlook changes as soon as there are disturbances in wound healing or infections. Furthermore, the development of meatus stenosis is considerably worse in an untreated state. Here, the patient is threatened with an unfavorable course of the disease. There is a backlog of urine, which significantly impairs the functional activity of the kidneys. There is a possibility that a life-threatening condition will develop. If no action is taken even at this stage, the patient is likely to die prematurely.

Prevention

Preventing meatus stenosis is almost impossible. For example, in some cases it has existed since birth. In addition, the specific causes of the narrowing are often unclear.

Aftercare

The quality of life of affected individuals is significantly reduced and limited by meatus stenosis, which is why it is treated in most cases with the help of surgery. Normally, no further complications occur during treatment. However, disturbances in wound healing may occur. In this case, affected persons must additionally take antibiotics. The life expectancy of affected persons is usually not limited or reduced. A high age can be reached.

What you can do yourself

Meatus stenosis must be treated surgically in any case. Accordingly, self-help measures focus on relieving discomfort and promoting recovery after urethral surgery. In the first days after the operation, the patient should take it easy. Physical work should be avoided, as well as exercise and other measures that could lead to tearing of the wound. After two to three weeks, the wound should be completely healed and the patient may resume normal physical activity. The area around the incision should be cared for as directed by the physician. With the understanding of the medical professional, natural ointments and lotions can be used to treat the wound. Suitable preparations include calendula ointment or zinc ointment. Applications with lemon balm or chamomile can also promote the healing of the wound. If wound healing disorders, bleeding or other complications develop, a visit to the doctor is indicated. Patients should generally see their doctor regularly after urethral surgery, because only regular check-ups can reliably rule out serious complaints and complications.