Meatoplasty/Meatotomy

Overview 

Meatoplasty is a surgical procedure performed to enlarge the urethral meatus, the opening at the tip of the penis (glans) where urine exits the body through the urethra. This surgery is typically recommended when the opening becomes too narrow, a condition known as meatal stenosis. 

Meatal stenosis is caused by irritation that leads to scarring, which can occur for several reasons. One common cause is circumcision, the surgical removal of the foreskin from the penis. Other causes include friction from a baby’s penis rubbing against a diaper and long-term use of urinary catheters. These factors contribute to the narrowing of the urethral opening, which can interfere with normal urination.A meatoplasty and a meatotomy are similar procedures, both involving the widening of the meatus, or opening of the urethra. In a meatoplasty, the surgeon cuts open the tip of the penis and remodels the meatus, often stitching the edges to reconstruct the tissue. A meatotomy, on the other hand, is less complex, typically involving only the widening of the meatus without reconstruction or the need for stitches. Despite these differences, the terms are often used interchangeably. 

Reasons for undergoing the procedure  

Meatoplasty is a surgical procedure used to treat meatal stenosis, a condition where the urethral meatus (the opening of the urethra) becomes too narrow. Meatal stenosis can be congenital (present at birth) or develop later in childhood, typically between the ages of 3 and 7. It primarily affects circumcised children.  

Symptoms of meatal stenosis: 

• Difficulty aiming the urine stream. 
• A narrow or fast urine stream, or one that exits the urethra in an upward or sideways direction. 
• Urine spraying in different directions. 
• Frequent urination. 
• Pain or a burning sensation during urination. 

Meatoplasty and hypospadias: 

Healthcare providers may also perform a meatoplasty in infants with a mild form of hypospadias, a congenital condition where the urethral meatus forms away from the tip of the penis, often on the shaft or elsewhere. 

Risk 

While a meatotomy is generally considered a safe procedure, it does carry some risks associated with any surgery. Potential risks include:  

• Bacterial infection
• Bleeding
• Blood clots
• Complications from anesthesia, such as fatigue, headache, nausea, vomiting, and difficulty urinating
• Inflammation
• Irritation
• Scarring  
• Urine spraying until the area has healed  
• Stinging or burning sensations during urination  

Before the procedure  

Before proceeding with a meatoplasty, you will first need to bring your child to their healthcare provider. They will review your child’s overall health and vital signs and conduct a physical examination of the penis. This examination may include:  

• Inspecting the meatus and measuring its width.  
• Asking questions about the direction of urine flow or any spraying.  
• Observing your child while urinating to assess if the stream is straight.  
• Measuring the flow rate or the strength of the urine stream.

Additionally, the healthcare provider will inquire about any history of bleeding disorders and should be informed if your child is taking any prescription or over-the-counter medications. Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and some herbal supplements, can increase the risk of bleeding during the procedure.  

Inform the provider if your child has any allergies, including:  

• Allergies to medications  
• Latex allergy  
• Food allergies  
• Allergies to skin cleaners, such as iodine or isopropyl alcohol 

The healthcare provider will also explain the procedure to you in detail. Being informed about the procedure and having the opportunity to ask questions can help you stay calm, which in turn can help your child feel more at ease.

It’s important to be mindful of your tone of voice and facial expressions, as children can often pick up on these cues. Reading your child their favorite book or letting them play with their favorite toys before the surgery can be comforting. Although your child may not fully understand the situation, maintaining a calm demeanor can help them feel more relaxed.

During the procedure  

Before a meatoplasty, a healthcare provider will prepare your child by cleaning the area with a skin sanitizer and applying a numbing cream. A pediatric anesthesiologist will then administer anesthesia to ensure that your child remains asleep and pain-free throughout the procedure.

The healthcare provider will follow these steps:  

1. Insert a soft tube into the meatus to measure its width.  
2. Make a V-shaped incision below the meatus at the base of the penis to enlarge the opening.  
3. Use surgical glue or stitches (sutures) to close the incision and promote healing.  
4. Inspect the meatus for any additional narrow areas.  
5. Place a urinary catheter if necessary to assist with urination.

In some cases, a meatotomy can be performed in an office setting without general anesthesia if your child is able to tolerate it. Before proceeding, the healthcare provider will apply a numbing lotion to your child’s penis and wait 30 to 60 minutes for it to take effect. The provider will then clamp the tissue and make an incision to widen the opening, without using stitches.  

Typically, a meatoplasty takes less than an hour. While a meatotomy may cause some discomfort, it is normal for your child to experience stinging or burning during urination for a week or two. A small amount of bloody discharge is also common.  

After the procedure  

Following the meatoplasty, the anesthesiologist will stop administering anesthesia, and your child will be moved to a recovery room by the nursing staff. There, they will be monitored as they awaken and their overall condition is assessed. Typically, this procedure is done on an outpatient basis, allowing your child to return home the same day. However, if the surgery was for severe meatal stenosis, a hospital stay of a few days might be necessary for proper recovery.  

You will receive specific care instructions from the healthcare provider for your child’s recovery, especially during the initial week. Pain relief medication may also be prescribed to help manage any discomfort.

Outcome 

Meatoplasty generally has an excellent success rate, with many children experiencing a favorable prognosis and finding it to be a safe treatment option. After healing, complications are uncommon, and follow-up care is rarely needed.

The procedure provides several benefits, including the enlargement of the urethral meatus and the resolution of urination issues. Specifically, it helps address challenges like difficulty aiming the urine stream and unwanted spraying.

Each child’s recovery process is unique, but most children start to feel better within a week. During the initial days after surgery, they may require extra rest, as sleep promotes a quicker recovery.  

For at least a week following the procedure, it’s essential for your child to avoid strenuous activities. This includes refraining from using straddling toys such as bicycles, rocking horses, swings, or seesaws, as well as steering clear of sports or other vigorous physical activities.

Be sure to schedule regular follow-up appointments with your child’s healthcare provider to ensure that their penis is healing properly. If you notice any complications or unusual symptoms after the meatoplasty, take your child to the nearest emergency room immediately. These symptoms may include:  

• A consistently dry diaper  
• A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher  
• Difficulty urinating  
• Heavy bleeding  
• Increased pain  
• Vomiting three or more times a day