How is the condition of urethral meatus stenosis created and how is it identified?
Your child is about to undergo a surgery called meatotomy (widening of the urethral meatus). This surgery is performed on children diagnosed with urethral meatus stenosis. This is a common condition among children who have undergone circumcision. Although there is no direct link between circumcision and urethral meatus stenosis, the exposure of the penis tip after the removal of the foreskin, along with its contact with the sponge-like spongy urethral tissue, can sometimes cause chemical irritation to the penis tip. This irritation can lead to the tightening of the urethral meatus and the subsequent development of stenosis.
There are several signs that indicate urethral meatus stenosis, such as deviation in the direction of urine flow (the child urinating upwards, over a long distance, etc.), interruptions in the urine stream, and even difficulty in urination to the point of urinary retention requiring catheterization of the bladder. Sometimes children complain of pain during urination, accompanied by discharge from the meatus and signs of inflammation in the urethral meatus.
Why is it important to treat urethral meatus stenosis?
At first glance, it might seem like a minor condition causing some discomfort, not necessarily a medical problem. However, this assumption is incorrect. Symptoms such as difficulty in urination and deviations in the direction of urine flow are clear signs of obstruction in the urinary pathways. In the long run, this obstruction can lead to complete urinary retention or irreversible functional impairments of the bladder. These complications can be resolved by performing a meatotomy, during which the urethral meatus is enlarged.
What are the surgical procedures?
Two weeks after your visit to the pediatric urology department at Shaare Zedek or after being referred from a community urologist to the pediatric urology department at Shaare Zedek, you will be scheduled for a preoperative clinic visit. During this visit, a hospitalization file will be opened for your child and a basic physical examination will be performed. Prior to this visit, you should prepare the following documents:
- Commitment to the preoperative clinic visit.
- Letter from a pediatrician or family doctor confirming the suitability for general anesthesia.
- Blood test results.
The referral for blood tests can be obtained from the pediatrician or family doctor when you receive the preoperative clinic appointment. If your child has any medical conditions, you must inform the urologist who referred your child for surgery. It is the responsibility of the parents to provide an approval from the relevant specialist dealing with the specific problem the child is suffering from. No procedure will be performed without preoperative approval.
After the preoperative clinic visit, you will be notified (by phone) of the surgical date and instructions for the surgery. In general, the instructions include fasting for 6 hours before surgery. However, breastfeeding infants (breast milk only) are allowed up to 4 hours before surgery. Clear fluids such as tea, water, or diluted apple juice can be given up to 2 hours before the surgery. Any deviation from these instructions will result in the cancellation of the surgery, with the responsibility lying solely with the parents.
The surgery is performed under general anesthesia with the addition of local anesthesia. The meatotomy procedure is done as a surgical day care, meaning the patient is released on the same day of the surgery.
Postoperative Care and Follow-Up
After the surgery, a doctor from the department will guide the parents on how to care for the surgical wound. The parents should open and close the surgical site twice a day to prevent repeated infection of the incision edges. During the opening and closing of the urethral meatus, the surgical site should be treated with an ointment called Syntomycin 5%. You will receive the first tube of this ointment from the medical staff after the surgery.
Occasionally, leakage may occur from the surgical area during the opening of the surgical site. Gentle pressure on the penis tip, following the instructions given upon release, can stop the leakage. We recommend that the child return to regular activities in kindergarten or school the day after the surgery.
One week after the surgery, you should return for a follow-up visit with the urologist who referred your child for surgery. You must come to the follow-up visit exactly one week after the surgery. You are entitled to receive this appointment, and you must ensure that you receive it on time.