Outcome of surgical meatoplasty versus meatal dilatation in children with post circumcision meatal stenosis

Abstract

Background : Meatal stenosis is a condition is occurred in 8% to 9% of male child after neonatal circumcision , Many theories described the etiology of development of meatal stenosis,those are either sever meatal inflammation or due to meatal devascularization caused by cutting of frenular artery during circumcision or due to meatal ammonitis  , meatal stenosis dose not become apparent till the child is toilet trained, Dysurea , frequency , terminal heamaturia and incontinence are the leading symptoms to discover meatal stenosis, the condition rarely cause a change in the upper urinary tracts. Meatal stenosis is treated either by surgical meatoplasty or periodic dilatation.

Aims: To evaluate the symptomatic improvement in children with urethral meatal stenosis after surgical meatoplasty and compare it with conservative periodic meatal dilatation with hydrocortisone cream.

Patients and method: 23 child with variable degree of meatal stenosis their age were between 2.5 years to 5 years examined in private clinic for their symptoms, undergone complete evaluation including physical examination, laboratory urine analysis , ultrasounic examination for assessment of the bladder and upper urinary tract , and biochemical tests. The 23 patients were divided into 2 group A (12 child) and group B (11 child).

Group A were treated by weekly dilatation using sound metal dilator size 10/12 French , for 4 weeks, Also hydrocortisone 2.5% cream for 3 days implicated to the meatus following each dilatation session.

Group B was treated by surgical meatoplasty (1)

Results: Two month after the procedures all patients in group A , B were re examined: In group A 10 patients (83.3 eYo) developed re stenosis and just 2patients (16.6%) still had adequate urethral meatal opening. In group B 10 patients (90.9%) had good symptomatic improvement and adequate urethral opening, just one( 9%) patient still has obstructive urethral symptom .

Conclusions: Surgical meatoplasty should be considered other than conservative meatal dilatation in definitive treatment of meatal stenosis in children.