Urinary tract infections - increased susceptibility due to stricture
Causesedit
The protection provided by the foreskin for the glans penis and meatus has been recognized since 1915. In the absence of the foreskin the meatus is exposed to mechanical and chemical irritation from ammoniacal diaper (nappy) that produces blister formation and ulceration of the urethral opening, which eventually gives rise to meatal stenosis (a narrowing of the opening).[1] Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.[1][2]
Risk factorsedit
Frisch & Simonsen (2016) carried out a very large-scale study in Denmark, which compared the incidence of meatal stenosis in Muslim males (mostly circumcised) with the incidence of meatal stenosis in ethnic Danish males (mostly non-circumcised). The risk of meatal stenosis in circumcised males was found to be as much 3.7 times higher than in the non-circumcised males.[1]
According to Frisch & Simonsen (2016), "the foreskin is protective against urinary stricture disease" (meatal stenosis).[1] Frisch & Simonsen (2016) call for a "thorough reassessment of the burden of urethral troubles and other adverse outcomes after non-therapeutic circumcision of boys."[1]
After hypospadias repairedit
Meir & Livne (2004) suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]",[3] while Jayanthi (2003) recommends the use of a modified Snodgrass hypospadias repair.[4]
Treatmentedit
In females, meatal stenosis can usually be treated in the physician's office using local anesthesia to numb the area and dilating (widening) the urethral opening with special instruments.[citation needed]
In males, it is treated by a second surgical procedure called meatotomy in which the meatus is crushed with a straight mosquito hemostat and then divided with fine-tipped scissors.[5] Recently, home-dilatation has been shown to be a successful treatment for most boys.[6]
Prognosisedit
Most people can expect normal urination after treatment.[5]
Incidenceedit
Numerous studies over a long period of time clearly indicate that male circumcision contributes to the development of urethral stricture. Among circumcised males, reported incidence of meatal stricture varies. Griffiths et al. (1985) reported an incidence of 2.8 percent.[7] Sörensen & Sörensen (1988) reported 0 percent.[8] Cathcart et al. (2006) reported an incidence of 0.55 percent.[9] Yegane et al. (2006) reported an incidence of 0.9 percent.[10] Van Howe (2006) reported an incidence of 7.29 percent.[2] In Van Howe's study, all cases of meatal stenosis were among circumcised boys. Simforoosh et al. (2010) reported an incidence of 0.55 percent.[11] According to Emedicine (2016), the incidence of meatal stenosis runs from 9 to 20 percent.[5] Frisch & Simonsen (2016) placed the incidence at 5 to 20 percent of circumcised boys.[1]
Referencesedit
^ abcdefFrisch M, Simonsen J (April 2018). "Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013". The Surgeon. 16 (2): 107–118. doi:10.1016/j.surge.2016.11.002. PMID 28017691. Published online ahead of print on 22 December 2016.
^ abVan Howe RS (2006). "Incidence of meatal stenosis following neonatal circumcision in a primary care setting". Clinical Pediatrics. 45 (1): 49–54. doi:10.1177/000992280604500108. PMID 16429216.
^Meir DB, Livne PM (June 2004). "Is prophylactic antimicrobial treatment necessary after hypospadias repair?". The Journal of Urology. 171 (6 Pt 2): 2621–2. doi:10.1097/01.ju.0000124007.55430.d3. PMID 15118434.
^Jayanthi VR (October 2003). "The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis". The Journal of Urology. 170 (4 Pt 2): 1603–5, discussion 1605. doi:10.1097/01.ju.0000085260.52825.73. PMID 14501672.
^ abcKoenig JF (22 September 2016). "Meatal stenosis". EMedicine. Retrieved 21 August 2017.
^Searles JM, MacKinnon AE (March 2004). "Home-dilatation of the urethral meatus in boys". BJU International. 93 (4): 596–7. doi:10.1111/j.1464-410X.2003.04680.x. PMID 15008738. S2CID 8817008.
^Griffiths DM, Atwell JD, Freeman NV (1985). "A prospective survey of the indications and morbidity of circumcision in children". European Urology. 11 (3): 184–7. doi:10.1159/000472487. PMID 4029234.
^Sörensen SM, Sörensen MR (1988). "Circumcision with the Plastibell device. A long-term follow-up". International Urology and Nephrology. 20 (2): 159–66. doi:10.1007/BF02550667. PMID 3384610. S2CID 29147788.
^Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE (July 2006). "Trends in paediatric circumcision and its complications in England between 1997 and 2003". The British Journal of Surgery. 93 (7): 885–90. doi:10.1002/bjs.5369. PMID 16673355. S2CID 42869269.
^Yegane RA, Kheirollahi AR, Salehi NA, Bashashati M, Khoshdel JA, Ahmadi M (May 2006). "Late complications of circumcision in Iran". Pediatric Surgery International. 22 (5): 442–5. doi:10.1007/s00383-006-1672-1. PMID 16649052. S2CID 26365305.
^Simforoosh N, Tabibi A, Khalili SA, Soltani MH, Afjehi A, Aalami F, Bodoohi H (June 2012). "Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: a large prospective study with long-term follow up using Plastibell". Journal of Pediatric Urology. 8 (3): 320–3. doi:10.1016/j.jpurol.2010.10.008. PMID 21115400.
External linksedit
January 01, 1970
meatal, stenosis, urethral, meatal, stenosis, narrowing, stenosis, opening, urethra, external, meatus, thus, constricting, opening, through, which, urine, leaves, body, from, urinary, bladder, urethral, meatal, stenosisother, namesurethral, stricturespecialtyu. Urethral meatal stenosis is a narrowing stenosis of the opening of the urethra at the external meatus m iː ˈ eɪ t e s thus constricting the opening through which urine leaves the body from the urinary bladder Urethral meatal stenosisOther namesUrethral strictureSpecialtyUrology Contents 1 Symptoms and signs 2 Causes 3 Risk factors 4 Diagnosis 5 Prevention 5 1 In the newborn 5 2 After hypospadias repair 6 Treatment 7 Prognosis 8 Incidence 9 References 10 External linksSymptoms and signs editAbnormal strength and direction of urinary stream Visible narrow opening at the meatus in boys Irritation scarring or swelling of the meatus in boys Discomfort with urination dysuria and frequency Incontinence day or night Bleeding hematuria at end of urination Urinary tract infections increased susceptibility due to strictureCauses editThe protection provided by the foreskin for the glans penis and meatus has been recognized since 1915 In the absence of the foreskin the meatus is exposed to mechanical and chemical irritation from ammoniacal diaper nappy that produces blister formation and ulceration of the urethral opening which eventually gives rise to meatal stenosis a narrowing of the opening 1 Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision 1 2 Risk factors editFrisch amp Simonsen 2016 carried out a very large scale study in Denmark which compared the incidence of meatal stenosis in Muslim males mostly circumcised with the incidence of meatal stenosis in ethnic Danish males mostly non circumcised The risk of meatal stenosis in circumcised males was found to be as much 3 7 times higher than in the non circumcised males 1 Diagnosis editIn males history and physical exam is adequate to make the diagnosis In females VCUG voiding cystourethrogram is usually diagnostic Other tests may include citation needed Urine analysis Urine culture CBC basic metabolic panel Renal and bladder ultrasoundPrevention editIn the newborn edit According to Frisch amp Simonsen 2016 the foreskin is protective against urinary stricture disease meatal stenosis 1 Frisch amp Simonsen 2016 call for a thorough reassessment of the burden of urethral troubles and other adverse outcomes after non therapeutic circumcision of boys 1 After hypospadias repair edit Meir amp Livne 2004 suggest that use of a broad spectrum antibiotic after hypospadias repair will probably reduce meatal stenosis rates 3 while Jayanthi 2003 recommends the use of a modified Snodgrass hypospadias repair 4 Treatment editIn females meatal stenosis can usually be treated in the physician s office using local anesthesia to numb the area and dilating widening the urethral opening with special instruments citation needed In males it is treated by a second surgical procedure called meatotomy in which the meatus is crushed with a straight mosquito hemostat and then divided with fine tipped scissors 5 Recently home dilatation has been shown to be a successful treatment for most boys 6 Prognosis editMost people can expect normal urination after treatment 5 Incidence editNumerous studies over a long period of time clearly indicate that male circumcision contributes to the development of urethral stricture Among circumcised males reported incidence of meatal stricture varies Griffiths et al 1985 reported an incidence of 2 8 percent 7 Sorensen amp Sorensen 1988 reported 0 percent 8 Cathcart et al 2006 reported an incidence of 0 55 percent 9 Yegane et al 2006 reported an incidence of 0 9 percent 10 Van Howe 2006 reported an incidence of 7 29 percent 2 In Van Howe s study all cases of meatal stenosis were among circumcised boys Simforoosh et al 2010 reported an incidence of 0 55 percent 11 According to Emedicine 2016 the incidence of meatal stenosis runs from 9 to 20 percent 5 Frisch amp Simonsen 2016 placed the incidence at 5 to 20 percent of circumcised boys 1 References edit a b c d e f Frisch M Simonsen J April 2018 Cultural background non therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease Two nationwide register based cohort studies in Denmark 1977 2013 The Surgeon 16 2 107 118 doi 10 1016 j surge 2016 11 002 PMID 28017691 Published online ahead of print on 22 December 2016 a b Van Howe RS 2006 Incidence of meatal stenosis following neonatal circumcision in a primary care setting Clinical Pediatrics 45 1 49 54 doi 10 1177 000992280604500108 PMID 16429216 Meir DB Livne PM June 2004 Is prophylactic antimicrobial treatment necessary after hypospadias repair The Journal of Urology 171 6 Pt 2 2621 2 doi 10 1097 01 ju 0000124007 55430 d3 PMID 15118434 Jayanthi VR October 2003 The modified Snodgrass hypospadias repair reducing the risk of fistula and meatal stenosis The Journal of Urology 170 4 Pt 2 1603 5 discussion 1605 doi 10 1097 01 ju 0000085260 52825 73 PMID 14501672 a b c Koenig JF 22 September 2016 Meatal stenosis EMedicine Retrieved 21 August 2017 Searles JM MacKinnon AE March 2004 Home dilatation of the urethral meatus in boys BJU International 93 4 596 7 doi 10 1111 j 1464 410X 2003 04680 x PMID 15008738 S2CID 8817008 Griffiths DM Atwell JD Freeman NV 1985 A prospective survey of the indications and morbidity of circumcision in children European Urology 11 3 184 7 doi 10 1159 000472487 PMID 4029234 Sorensen SM Sorensen MR 1988 Circumcision with the Plastibell device A long term follow up International Urology and Nephrology 20 2 159 66 doi 10 1007 BF02550667 PMID 3384610 S2CID 29147788 Cathcart P Nuttall M van der Meulen J Emberton M Kenny SE July 2006 Trends in paediatric circumcision and its complications in England between 1997 and 2003 The British Journal of Surgery 93 7 885 90 doi 10 1002 bjs 5369 PMID 16673355 S2CID 42869269 Yegane RA Kheirollahi AR Salehi NA Bashashati M Khoshdel JA Ahmadi M May 2006 Late complications of circumcision in Iran Pediatric Surgery International 22 5 442 5 doi 10 1007 s00383 006 1672 1 PMID 16649052 S2CID 26365305 Simforoosh N Tabibi A Khalili SA Soltani MH Afjehi A Aalami F Bodoohi H June 2012 Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection a large prospective study with long term follow up using Plastibell Journal of Pediatric Urology 8 3 320 3 doi 10 1016 j jpurol 2010 10 008 PMID 21115400 External links edit Retrieved from https en wikipedia org w index php title Meatal stenosis amp oldid 1187122886, wikipedia, wiki, book, books, library,
