Meatotomy

Overview

Meatal stenosis is a condition that requires a meatotomy (tightening or narrowing). Rare cases are found during circumcision or in males who have not yet had their circumcisions, although the majority appear months or longer after circumcision. It is believed that since the meatus is no longer protected by the foreskin, it is now vulnerable to irritation from a urine-soaked diaper and develops scars as a result. Parents will observe that their baby's urine spurts in many directions or shoot upward uncontrollably. A procedure is required to address the illness because there is no appropriate medical treatment. Meatotomy is carried out as an outpatient procedure, typically while your child is asleep due to a general anesthetic. To lessen the pain when the child awakens, some surgeons will additionally administer a local injection of a long-lasting local anesthetic. However, it is rarely necessary. Usually, the recovery period is relatively short. Sometimes this treatment can be carried out in the office using only a local anesthetic.

What is Meatotomy?

Meatotomy is a procedure to expand the meatus. The meatus is the body's exit point for urine, located at the tip of the penis. Because the meatus is too narrow, meatotomies are frequently performed. That is a condition known as urethral stricture or meatal stenosis. About 20% of circumcised males experience this. The meatus may also be removed if it is covered in a thin or webbed skin layer. The majority of young, circumcised males who have this procedure are males.

Meatotomy Candidates

Males with a narrow meatus, who have trouble aiming their urine stream or even experience discomfort when they urinate, are sometimes treated with a meatotomy. Meatotomy can be performed on a child as young as 3 months old because it is a safe, relatively painless treatment. If your child exhibits any of the following signs of meatal stenosis or other conditions that can narrow the meatus, you should take them to the doctor:

Difficulties directing the flow of their urine.
Their stream of the urine rises rather than dropping or spraying.
Urinary discomfort (dysuria).
Having frequent urination.
Feeling of residual urine in the bladder after urination.

Meatotomy Preparation

Your healthcare professional will probably request imaging tests and/or perform a cystoscopy to determine the size and severity of the stenosis. To verify and make sure you're in good health, he might also prescribe some blood tests.

Your urine will also be examined to make sure there are no bacteria present. Your doctor might request a heart electrocardiogram (ECG) based on your age and any existing heart issues you might have.

With your healthcare practitioner, you will go through your medical history as well as the procedure for the surgery and any potential dangers. Because you might need to stop taking some medications a few days or weeks before your meatotomy, you should anticipate discussing all medications and drugs you're now using with your healthcare professional.

You should carefully read the consent form that you will be asked to sign. Additionally, be sure to clarify any parts or components of the form that are unclear to you.

How to Get Ready?

You are encouraged to refrain from eating for at least six to eight hours before the allotted time for your meatotomy, and you are only permitted to consume clear liquids up to two hours before surgery because you will be given an anesthetic. Your healthcare practitioner should make sure that you understand everything.

Ask your healthcare practitioner how to take any daily prescriptions on the day of your procedure if you have any questions. Typically, the procedure lasts for 30 minutes.

Things to Bring

It is advised that you bring in a pair of comfortable, loose-fitting underwear because you will probably be going home with a catheter to drain your bladder for one to several days after the treatment and to let the site of your previous meatal stricture heal.
You should think about bringing dark underwear instead of light-colored underwear since light-colored underwear may make any post-operative bleeding appear and feel more serious.
If at all feasible, bring a light meal that you can consume after the procedure because it's likely that you won't have eaten in several hours.
It is advised to bring a case for your glasses or hearing aids if you wear them.

Meatotomy Procedure

The process can take between 15 and 30 minutes. To prevent blood flow, the little piece of skin that partially covers the meatus is pinched before being sliced. After that, the doctor gauges the opening's size to see if it is adequate. To assist avoid a recurrence, one or two tiny sutures are frequently inserted on either side.

A suture is occasionally required to stop a tiny blood artery from bleeding. Other times, no sutures are inserted. The freshly opened meatus is then covered with an antibiotic ointment. Dressings are not required.

In Recovery Room

Your condition will be observed while you are in the recovery area. At regular intervals, a nurse should check the following:

Your vital signs, including your heart rate, temperature, pulse, and breathing.
Your level of pain and how well the painkillers you have been prescribed are working for you.
The amount and ease with which you are passing urine.

Your blood may be injected with fluids and painkillers (which are frequently unneeded) via an intravenous (IV) drip. An oxygen mask may also be attached to you to aid with breathing. You will eventually be transferred to a ward in preparation for your discharge once you are completely awake and at ease.

What Happens After Meatotomy?

The majority of patients return home the same day as their operation, however, depending on the situation, you might be required to stay as an inpatient for an extra day. Many hospitals prefer that you have another adult ready to drive or take you home following the surgery because anesthesia is used. It is advised that you wait at least 24 hours following the surgery to drive or handle any heavy machinery due to the anesthesia's residual effects.

Your healthcare practitioner or attending nurse should be made aware of any pain or discomfort you may be experiencing before you leave so that they can put the best pain treatment method in place for you. It's common to feel some discomfort following the procedure, as well as intense urges to urinate and/or a burning feeling in your urethra.

The catheter inserted during the procedure will probably need to stay in for a few days. The main goal of this is to maintain the space's openness and allow it to heal naturally. You should anticipate the following in the meantime:

Your healthcare professional will provide you with instructions on how to manage a preexisting catheter or perform self-catheterization.
Additionally, your doctor will let you know when to come back to the clinic or hospital for removal.
To lower your risk of developing an infection after surgery, your doctor can prescribe antibiotics for you. To further reduce the danger, you should practice proper hygiene.
After a few days, you will be able to get around and probably go back to work.
For a few weeks, you should refrain from having any sexual activity. The best person to advise you on how long you should refrain is your healthcare practitioner.
Up until your practitioner gives you the all-clear, stay away from demanding tasks and strenuous exercise.
It's important to avoid straining while having a bowel movement. To avoid constipation, it is advised that you drink plenty of fluids and switch to a high-fiber diet for a while following the procedure. You might also need to take laxatives or stool softeners. You should talk to your healthcare physician about this.

At Home Care

Some patients experience almost no discomfort, while others experience mild discomfort for one to two days; prolonged discomfort is uncommon. The first few times your child uses the restroom, he might cry. The urine's effect on the freshly cut tissue could cause him to experience a stinging or burning sensation. He may use any pediatric-dose over-the-counter medication (Tylenol, Advil, or other nonsteroidal medication) to which he is not allergic if he is in discomfort. The doctor will check the hole to make sure it remained open when he follows up in the office. The sutures, if any, dissolve on their own and don't need to be taken out. You might be instructed to apply an antibiotic ointment (such as Bacitracin) to the region for the first two to three days to stop the sutures or skin from adhering to diapers or undergarments. The cream might also aid in preventing recurrence. Some doctors may advise you to give your son a warm bath a few times each day. For the first few days, some people may urge you to gently spread the hole apart a few times a day to help to prevent the edges from adhering to one another.

Meatotomy Complications

After having a meatotomy, you could experience several complications. Among the most typical ones are:

Urethral pain. Urinary discomfort After surgery, it's typical to have some soreness or burning when peeing for a few days.
Bleeding. You frequently give out some blood along with your urine. Within a week of your procedure, this should go away. Inform your healthcare practitioner if it continues or if you notice any clots.
Infection. You should contact your doctor right away if you think you could develop a urinary tract infection following surgery. Fever and chills are classic signs of an infection.
Stenosis recurrence. Your urethra may likely constrict or form a stricture once more. You could need to have a meatotomy or another similar procedure, depending on the results of further discussion with your healthcare practitioner.

Other unusual and serious consequences include:

Excessive bleeding.
Swelling of the penis.
Inability to pass urine.

You need to tell your healthcare physician right away if any of these three occur.

Smoking is a significant factor that raises the chance of problems following surgery. Smoking can hurt how quickly a wound heals. You might benefit from starting nicotine replacement treatment before surgery to lower your risk of experiencing major problems. In any case, if you smoke, you should let your doctor know so they can advise you on the best way to proceed.

Bleeding problems and blood-thinning drugs are additional factors that can raise your risk of complications. Inform your healthcare provider if you suffer from a blood clotting disease or are taking any medications, such as aspirin, that may accidentally or deliberately impair your body's ability to clot blood.

Meatotomy Results

Your child's pee stream shouldn't be spraying or deflecting upward anymore. Once more, he can have discomfort the first few times he urinates. Encourage him to stop holding back the urine. He may benefit from being placed in a warm tub to urinate sometimes.

Almost all meatotomies remain open. The opening might need to be redone in the unlikely case that it scars down. Because doctors know and anticipate that a small portion of the cut tissue may heal through scarring, they frequently make the meatus wider than is necessary for a healthy outcome. The penis may appear bent or broad due to possible swelling. Within the following one to two weeks, the swelling will go away.

If sutures are used, they will break and fall out spontaneously within one to three weeks. You shouldn't be concerned if a suture breaks quickly (that day or within a few days). Most likely, it has already achieved its goal.

Meatotomy Follow-Up

When it is time for the surgeon to remove the catheter, you will come back to the office or hospital as directed. To determine how quickly and completely your bladder empties itself, a uroflowmetric study or post-void residual study may be carried out.

You will be asked to urinate in a device or special toilet so that the scientists can measure your urine output, quality, flow rate, and time required to urinate. You will be given the go-ahead to return a few weeks later for another check-up so that a urinalysis and possibly another uroflowmetric testing can be done. It's crucial that you discuss any concerns or disturbing symptoms with your healthcare physician at these follow-up visits.

Conclusion

If your child has a narrow or obstructed meatus that prevents them from peeing normally, meatotomy is an effective procedure. The majority of children who undergo this procedure have a very good prognosis and hardly ever require any more follow-up care for problems or other surgeries.