Meatotomy Surgery

What is Meatotomy Procedure?

Meatotomy is a surgical procedure that enlarges the meatus, which is the opening at the tip of the penis through which urine exits the body.

This surgery is typically necessary when the meatus becomes too narrow, a condition known as meatal stenosis or urethral stricture, which affects about 20% of circumcised males. It may also be performed to correct issues such as thin or webbed skin covering the meatus.

Meatotomy is most commonly performed on young males who have been circumcised.

What’s the difference between meatotomy and meatoplasty?

Meatoplasty involves making an incision at the tip of the child's penis, specifically in the glans, to widen the area around the meatus, which facilitates easier urination. The edges of the incision are then sutured to maintain the new, wider opening, potentially creating a significantly larger exit for urine.

In contrast, a meatotomy simply enlarges the opening of the meatus without the use of stitches and generally does not involve altering the surrounding tissue. This procedure directly expands the urinary opening to improve flow.

Who needs to consider this procedure?

Meatotomy is often recommended for males who experience difficulty in directing their urine stream or pain during urination due to a narrow meatus. It is a safe and generally painless procedure that can be performed on children as young as 3 months.

If your child exhibits any of the following symptoms, it might indicate meatal stenosis or another condition causing the narrowing of the meatus:

• Difficulty directing their urine stream
• Urine stream spraying or not flowing downward
• Pain during urination (dysuria)
• Frequent urination
• A sensation of incomplete bladder emptying after urinating

Consult your doctor if your child is experiencing any of these symptoms to determine if a meatotomy might be necessary.

How is a Meatotomy procedure performed?

Meatotomy is usually performed as an outpatient procedure, meaning the patient can go home the same day without an overnight hospital stay. Various anesthesia options are available to ensure the patient's comfort during the surgery:

• Topical Anesthesia: An anesthetic cream, such as lidocaine (EMLA), is applied to the tip of the penis to numb the area. 
• Local Anesthesia: Anesthesia is injected into the head of the penis to cause numbness.
• Spinal Anesthesia: Anesthesia is administered into the lower back to numb the lower half of the body. 
• General Anesthesia: Patient will be completely asleep during the surgery and will wake up afterwards.

Procedure Steps:

1. The tip of the penis is sterilized with an iodine solution.
2. A sterile drape is wrapped around the penis.
3. The tissue at one side of the meatus is crushed to facilitate the incision.
4. A V-shaped incision is made at the bottom of the penis starting from the meatus.
5. The tissue is sutured back together to shape the meatus into a slit, ensuring proper healing and preventing future complications.
6. A probe is inserted into the meatus to check for any remaining narrow areas.
7. In certain cases, a catheter is inserted to aid with urination post-surgery.

The patient can usually leave the outpatient facility shortly after the effects of anesthesia diminish. They might stay a few hours for postoperative monitoring and recovery.

For more extensive procedures, a hospital stay of up to 3 days may be required to ensure proper recovery.

Recovery after the procedure

Recovery after a meatotomy procedure is typically straightforward, but it's important to follow specific care guidelines to ensure a smooth and efficient healing process. Here are key points regarding recovery after meatotomy:

Immediate Post-Procedure Care:

• After the surgery, patient might experience mild to moderate discomfort, which can usually be managed with over-the-counter pain relievers, as recommended by your doctor.
• It's common for the area around the incision to be swollen and red for the first few days. Applying ice packs can help reduce swelling.
• Keep the area clean to prevent infection. Your doctor will provide specific instructions on how to gently clean the penis and the type of ointment to apply if needed.

Activity Restrictions:

• Patient should avoid strenuous activities for a few days to a week to prevent irritation or bleeding at the incision site.
• Bathing may be restricted initially; sponge baths may be recommended until the doctor advises that it's safe to take regular baths or showers.

Monitoring for Complications:

• Watch for signs of infection, such as increased redness, swelling, pus, or persistent pain at the surgery site. Also, keep an eye out for fever or unusual odor.
• Ensure that the patient can urinate normally. Difficulty urinating, changes in the urine stream, or excessive pain during urination should be reported to your healthcare provider.

Long-Term Care:

• Most patients recover fully within a week or two, with minimal long-term care needed.
• Encourage the patient to report any discomfort or issues related to urination as they grow, as further adjustments might be needed.

By adhering to these guidelines, ensuring regular follow-up, and maintaining good hygiene, recovery from a meatotomy is typically quick and uncomplicated, leading to an improvement in symptoms and overall quality of life.