meatalstenos

Meatal stenosis is a medical condition characterized by narrowing of the external opening of the urethra, the urinary meatus. The constriction most commonly affects the penile meatus in males and can lead to a weaker or spraying urinary stream, dysuria, and post-void dribbling. It can be congenital or acquired.

Acquired meatal stenosis often results from inflammation or scarring of the glans or urethral meatus. Common associations include complications of neonatal circumcision, balanitis, lichen sclerosus (BXO), infections, trauma, or urethral instrumentation. Less commonly, meatal stenosis may be part of broader congenital urethral or genital anomalies.

Clinical features include a visibly reduced meatal caliber on examination, sometimes a pinhole opening, and symptoms such as an abnormal urine stream or spraying. Diagnosis is usually clinical, supported by uroflowmetry or imaging if indicated. In uncertain cases, urethroscopy or cystoscopy can assess the caliber of the urethra distal to the meatus and help rule out distal strictures.

Management depends on severity and underlying cause. Mild stenosis may respond to gradual dilatation with urethral dilators or catheters, and inflammatory conditions may benefit from topical steroids or other anti-inflammatory treatments. Persistent or severe stenosis typically requires surgical intervention, such as a meatotomy (incision of the stenotic meatus) or meatoplasty to enlarge the opening; more extensive reconstruction may be needed if scarring is extensive. Treating underlying conditions (for example, controlling lichen sclerosus or infection) is important to reduce recurrence. Postoperative follow-up is essential to monitor for recurrence or complications.

Prognosis is generally favorable with appropriate treatment, though recurrence after dilation or surgery can occur, especially in cases associated with chronic inflammatory skin disease.