Name: Surgical Management of Meatal Stenosis with Meatoplasty (Video) | JoVE Journal
Uploaded: 2010-11-30T17:30:00.000+00:00
Duration: 4 min 53 s
Description: Learn surgical management of meatal stenosis using meatoplasty to restore normal urinary flow. This video demonstrates precise scar tissue excision and tissue re-approximation techniques for optimal outcomes.

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5 minutes

The author thanks the Johns Hopkins operating room staff, and Media Relations in the department of Pediatrics at Johns Hopkins Children's Hospital.

Introduction:
Genital disorders are commonly encountered in the offices of primary care physicians. Meatal stenosis, an abnormal narrowing of the urethral opening (meatus) is a common complication after circumcision occurring in 9%-10% of males. This disorder is characterized by an upward deflected, difficult-to-aim urinary stream, dysuria, urgency, frequent, and prolonged urination. If left untreated, this can lead to urinary tract infections and kidney problems. Surgical meatotomy/meatoplasty is curative.
Treatment/Diagnostics Procedure:
A routine urine analysis will rule out urinary tract infection or diabetes as potential causes of urinary frequency.
Detailed history and physical exam, include observation of micturition, confirm the diagnosis.
Outpatient surgery/meatoplasty is curative. The procedure is done under a 5-10 minute anesthetic.
Intraoperative preparation includes surgical loupe magnification, mosquito hemostat, fine tipped plastic microsurgical scissors, Castroviejo needle holder, and 7-0 vicryl suture;
<ol>
	<li>Child is placed in supine position.</li>
	<li>Minimal skin prep and drape of the genitalia. No prophylactic antibiotics needed.
	<ul>
		<li>Betadine POVIDONE IODINE solution is used to scrub the genital region, and allowed to remain for approximately 3 minutes prior to initial incision.</li>
		<li>The penis should be draped off with sterile towels.</li>
	</ul>
 </li>
	<li>A right handed surgeon will stand to the left side of the patient and one jaw of a well-lubricated mosquito hemostat is then introduced into the tip/ventral aspect of the urethral meatus to a depth of approximately 2-3 mm. The ventral tissue is then crushed by closing the hemostat. Total clamp time will be 60 seconds.</li>
	<li>The crushed ventral tissue is incised sharply with microsurgical scissors (figure 1) and the inner urethral mucosa and glanular tissue are reapproximated using 7-0 vicryl sutures (Castroviejo needle holder figure 2) in an interrupted fashion.</li>
</ol>
Recovery time is minimal, and a child is sent home with Tylenol as needed for discomfort. Vaseline is applied to the wound 3-4x/day.

<ol><li>Van Howe, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Incidence+of+meatal+stenosis+following+neonatal+circumcision+in+a+primary+care+setting%5BTitle%5D)+AND+%22Clin+Pediatr+%28Phila%29%22%5BJournal%5D)">Incidence of meatal stenosis following neonatal circumcision in a primary care setting.</a> Clin Pediatr (Phila). 45 (1), 49-54 (2006).</li>
<li>Litvak, A. S., Morris, J. A., McRoberts, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Normal+size+of+the+urethral+meatus+in+boys%5BTitle%5D)+AND+%22J+Uro%22%5BJournal%5D)">Normal size of the urethral meatus in boys.</a> J Uro. 115 (6), 736-737 (1976).</li>
<li>Brown, M. R., Cartwright, P. C., Snow, B. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Common+office+problems+in+pediatric+urology+and+gynecology%5BTitle%5D)+AND+%22Pediatr+Clin+North+Am%22%5BJournal%5D)">Common office problems in pediatric urology and gynecology.</a> Pediatr Clin North Am. 44 (5), 1091-1115 (1997).</li>
<li>Smith, C., Smith, D. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Office+pediatric+urologic+procedures+from+a+parental+perspective%5BTitle%5D)+AND+%22Urology%22%5BJournal%5D)">Office pediatric urologic procedures from a parental perspective.</a> Urology. 55 (2), 272-276 (2000).</li>
<li>Frank, J. D., Pocock, R. D., Stower, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Urethral+strictures+in+childhood%5BTitle%5D)+AND+%22Br+J+Urol%22%5BJournal%5D)">Urethral strictures in childhood.</a> Br J Urol. 62 (6), 590-592 (1988).</li>
<li>Persad, R., Sharma, S., McTavish, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+presentation+and+pathophysiology+of+meatal+stenosis+following+circumcision%5BTitle%5D)+AND+%22Br+J+Urol%22%5BJournal%5D)">Clinical presentation and pathophysiology of meatal stenosis following circumcision.</a> Br J Urol. 75 (1), 91-93 (1995).</li>
<li>Stenram, A., Malmfors, G., Okmian, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Circumcision+for+phimosis%3A+a+follow-up+study%5BTitle%5D)+AND+%22Scand+J+Urol+Nephrol%22%5BJournal%5D)">Circumcision for phimosis: a follow-up study.</a> Scand J Urol Nephrol. 20 (2), 89-92 (1986).</li>
<li>Hinman, F., Baskin, L. Chapter 155. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aHinman%2C+F+%22Hinman+s+Atlas+of+Pediatric+Urologic+Surgery%22">Hinman s Atlas of Pediatric Urologic Surgery</a>. , 2nd ed., 773-775 (2008).</li>
<li>Belman, A. B., King, L. R., Kramer, S. A. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aBelman%2C+AB+%22Clinical+Pediatric+Urology%22">Clinical Pediatric Urology</a>. , 4th ed, 214-215 (2002).</li>
<li>Wein, A. J., Kavoussi, L. R., Novick, A. C., Partin, A. W., Peters, C. A. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aWein%2C+AJ+%22Campbell-Walsh+Urology%22">Campbell-Walsh Urology</a>. , 9th ed, 1044-1045 (2007).</li>
</ol>

No conflicts of interest declared.

Outcome:
Symptomatic meatal stenosis is frustrating for the child and family. If left untreated, there is a potential for chronic incomplete bladder emptying, with occasional development of urinary tract infection and subsequent kidney damage.
Reconstructive meatoplasty is curative, and can be done under a brief anesthetic.
Conclusion:
Meatal stenosis is a common complication of circumcision. A thorough histor...

<table><tbody><tr><td>Betadine</td><td></td><td></td><td></td></tr><tr><td>Mosquito hemostat</td><td></td><td></td><td></td></tr><tr><td>Microsurgical scissor</td><td></td><td></td><td></td></tr><tr><td>Castroviejo needle driver</td><td></td><td></td><td></td></tr><tr><td>7-0 vicryl suture</td><td>Ethicon Inc.</td><td></td><td></td></tr></tbody></table>

surgical management of meatal stenosis with meatoplasty

Surgical Management of Meatal Stenosis with Meatoplasty

Meatal stenosis is a common urologic complication after circumcision. Children present to their primary care physicians with complaints of deviated urinary stream, difficult-to-aim, painful urination, and urinary frequency. Clinical exam reveals a pinpoint meatus and if the child is asked to urinate, he will usually have an upward, thin, occasionally forceful urinary stream with incomplete bladder emptying. The mainstay of management is meatoplasty (reconstruction of the distal urethra /meatus). This educational video will demonstrate how this is performed.

Meatoplasty, surgical management of meatal stenosis.

Meatal stenosis is a common urologic complication after circumcision.  Children present to their primary care physicians with complaints of deviated ...

This video demonstrates a surgical procedure to relieve me AAL obstruction. Following circumcision, allowing normal urinary flow and drainage, the child is placed in a supine position and the surgical site is prepped to prevent infection. Next, the hemostat is placed properly to achieve adequate urethral mutal caliber, and the scar tissue is removed.The scar tissue is then excised with precision using micro scissors. Finally, the mucosal and glandular tissue are re approximated to prevent recurrence. Hi, I'm Dr.Wong.I'm one the pediatric urologist here at Johns Hopkins. Today we perform procedure term Neal Plasty. The idea behind the procedure is to remove the ventral scar tissue that developed after a neonatal circumcision.If done properly, the success rate is close to a hundred percent and the cosmetic result is superb Mutal stenosis, an abnormal narrowing of the urethral opening is a common complication after circumcision occurring in nine to 10%of males and resulting in urinary frequency. A routine urine analysis will rule out urinary tract infection or diabetes as potential causes of urinary frequency. The physical exam should include tion confirming the mutal stenosis diagnosis.The equipment needed for intraoperative preparation includes surgical loop magnification, a mosquito hemostat fine tipped plastic microsurgical scissors, a Castro vijo needle holder, and a seven zero vicryl suture. Now let's see. The surgical procedure Begin by placing the child into a supine position.Minimally prep the skin and drape the genitalia. No prophylactic antibodies are needed. Use a Betadine povidone iodine solution to scrub the genital region and allow it to remain for approximately three minutes prior to the initial incision drape off the penis with sterile towels.A right-handed surgeon should stand on the left side of the patient and introduce one jaw of a well lubricated mosquito hemostat into the tip or ventral aspect of the urethral to a depth of approximately two to three millimeters. Now crush the ventral tissue by closing the hemostat. The total clamp time is 60 seconds.Using microsurgical scissors sharply inci the crushed ventral tissue. Next, use seven zero Vicryl sutures to re approximate the inner urethral mucosa and glandular tissue in an interrupted fashion. So this is probably the most difficult part of the procedure cause you really wanna avert that urethral mucosa out and tie your knots towards the outside of the natus.And with seven oh sutures, we generally put six knots. This is so fine. All right, so that looks great.The ADA is nice and open, and you can tell it's still slit like so that's a nice reconstruction. Okay, great. The recovery time is minimal and the child is sent home with Tylenol as needed for discomfort.Vaseline should be applied to the wound three to four times a day. Once the procedure has been mastered, it can be done in five to 10 minutes.

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Learn surgical management of meatal stenosis using meatoplasty to restore normal urinary flow. This video demonstrates precise scar tissue excision and tissue re-approximation techniques for optimal outcomes.

Surgical Management of Meatal Stenosis with Meatoplasty

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