Dr. Sean Elliott, MD
Reconstructive Urologist
Urethral Meatal Stenosis
What is meatal stenosis?
Urethral meatal stenosis is a narrowing of the opening of the urethra, which is the tube that carries urine from the bladder out of the body. This narrowing can occur in males or females, but is more common in males, and can lead to difficulty passing urine and other related problems.
What causes meatal stenosis?
In males, urethral meatal stenosis is often caused by repeated irritation or injury to the urethra, such as from catheterization, surgical procedures, or sexual activity. In some cases, it can also be caused by congenital abnormalities or certain medical conditions.
What are the symptoms of meatal stenosis?
Symptoms of urethral meatal stenosis may include a weakened or slow stream of urine, a narrow or "pinhole" urethral opening, discomfort or pain during urination, and an increased frequency of urination. Treatment options for urethral meatal stenosis depend on the severity of the condition, and may include urethral dilation or surgery to widen the urethral opening.
What are some of the treatments for meatal stenosis?
Dilation
Usually, the first step is to try dilating (or stretching) the meatal stenosis. This is usually done in a urologist’s office and is a common procedure for any urologist. A balloon or successively larger metal rods are used to stretch the opening. To prevent the stenosis from coming back again, a patient can self-dilate at home, usually with a cone-shaped plastic dilator (pictured below; available through common online marketplaces).
Meatotomy or meatoplasty
In the operating room, a cut is made on one side of the urethral opening to make it wider. The cut is continued, essentially unzipping the urethra, until a normal sized urethra is found. The cut is usually
Urethroplasty
This is a surgical reconstruction performed by reconstructive urologists, like Dr. Elliott. In the operating room a cut is made in one side of the urethra, but a tissue graft is added to the urethra to keep that area open. One example of a urethroplasty commonly performed by Dr. Elliott for this problem is the transmeatal buccal mucosa inlay procedure. “Transmeatal” means working through meatus; this means that we do not make any incisions on the penis and instead do all the stitching through the meatus opening. In this procedure, the scar tissue (in grey in the figure) is removed through the meatal opening using a very skinny scalpel. This leaves a raw surface inside the urethra where the scar used to be (shown in orange in the figure). Then a piece of tissue from the inside of the cheek (buccal mucosa graft, shown in gold in the figure) about the size of a fingernail is sewn into the inside of the urethra. This surgery has a very high success rate and helps maintain the cosmetic appearance of the penis because it does not require a long an opening in the skin as a meatotomy.
