A small and obstructive urethral meatal opening is most commonly acquired and thought to be secondary to circumcision that allows an ammoniacal meatitis (breakdown of the mucosa from constant contact with a wet diaper.) It is rarely congenital seen in instances of hypospadias .  It may occur in up to 10% of circumcised males and is very rare in the uncircumcised.  Symptoms may only be reported when the opening is exceptionally narrow, the stream may be diverted (often upward) and the skin may pouch out.  Burning is reported and blood noted on the diaper or in the underwear. In the adult and older child meatal stenosis is the result of infection, trauma, surgery, or failure of hypospadias repair.

 

Surgical revision with or without dilatation is most often curative and rarely buccal mucosal grafts are required.  The diagnosis is made by clinical observation and voiding urethrogram is only used when the history suggests a more proximal blockage.

 

 

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Carlos A Angel, MD  Meatal Stenosis   Emedicine