Dr. Sean Elliott, MD
Reconstructive Urologist
Meatoplasty / Meatotomy
A urethral stricture at the tip of the penis is called meatal stenosis. If the rest of the urethra is normal, then a very simple and very quick surgery with a fast recovery is a meatoplasty/meatotomy. In this surgery, we do not remove the scar tissue. Instead we “unzip” the urethra by cutting through the scar tissue and we keep cutting past the scar tissue for another 2 cm until we reach healthy urethra. We stitch that healthy urethra to the skin. This does not result in a new urethral opening; instead it results in a longer urethral opening, the tip of which still has scar in it but the inner end of it has healthy urethra.
perineum
front
Fig. 1: Urethral stricture is shown in pink, urethra in yellow, and incision in grey.
Fig. 2: Close up of the meatoplasty procedure ("invisible" skin).
Fig. 3: Close up of the meatoplasty procedure (with skin).
Transmeatal urethroplasty
A transmeatal urethroplasty means that the entire surgery is done through the small urethral opening in the head of the penis. This is an alternative to the quicker and easier meatoplasty/meatotomy surgery. This surgery takes slightly longer (60-90 minutes) and requires taking a skin graft from the cheek. The benefit is that the urethral opening can stay near the tip of the penis and does not need to get “unzipped” backwards.
Fig. 4: View of head of penis from the underside. Scar
tissue (in green) located <1 inch from tip.
Fig. 5: Very thin scalpel inserted through urethral opening.
Fig. 6: Scar tissue removed, leaving a raw pink surface underneath. This is then covered with a graft (in tan). The graft is about the size of a fingernail and comes from the inside of the cheek.
Fig. 7: Graft stitched to urethra with knots outside the skin by passing needles through urethra and out the penis skin.
Fig. 8: Stitches dissolve and urethra is normal size.