Meatus = the hole at the end of the urethra through which one urinates
Otomy = to make a hole or opening in
A meatotomy is performed for a condition referred to as meatal stenosis (tightening or narrowing). Although rare cases are discovered at the time of a circumcision or in an uncircumcised male, the vast majority present months or longer after circumcision. It is thought that the meatus, no longer covered by foreskin, is now exposed to irritation against a urine-soaked diaper, and consequently scars. Parents will notice that their baby's urine shoots upward, or that it uncontrollably sprays in multiple directions. There is no effective medical treatment and so a procedure is needed to correct the condition.
Meatotomy is performed as an ambulatory procedure, usually under general anesthesia so that your child is not aware of the procedure. Some surgeons will also use a local injection of along-acting local anesthetic agent to minimize pain upon when the child awakens. This is rarely necessary, however. The recovery time is typically very short. This procedure can sometimes be done in the office with just local anesthesia.
As with any procedure in which anesthesia is administered, you will be asked not to feed your child anything (including any liquids) after midnight on the evening prior to the surgery. If your child is on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. If safely avoidable, the procedure should no be performed if you child is on, or has recently been taking any medication that may interfere with his ability to clot his blood. This may not be of great concern for this procedure, however. The most common of these medications are aspirin-like compounds and all related pain relievers, fever reducers, or anti-inflammatory compounds(whether prescription or over-the-counter). Please refer to the attached list and tell us if he has taken any of these within the past 10 days. If his medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed any of the current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
To review the basics of what we discussed in the office: The procedure can take anywhere from 15-30 minutes. The tiny bit of skin that is partially covering the meatus is clamped (to interfere with blood supply) and then simply cut. We then look at the size of the opening to determine if it is large enough. In many instances, one or two very small sutures are placed on either side to help prevent a recurrence.
Sometimes a suture is needed to stop a small blood vessel from bleeding. In other instances, no sutures are placed. Sometimes an antibiotic ointment is then placed on the newly opened meatus. No dressings are necessary.
When done in the hospital, your child will be in the recovery room for a short time before being sent home. He may have some discomfort, but typically not any severe pain. It is not uncommon to see small drops of blood drip from the area. Try to keep the surgical area dry for 24 hours. If your child is older (walking/running age), we ask that he refrain from any strenuous activity or rough play for two days. Some patients have almost no discomfort while others are somewhat uncomfortable for one to two days; longer is rare. Your child may cry the first few times he urinates. He may have a stinging or burning sensation from the urine hitting the recently cut tissue. For discomfort, he may have any pediatric-dose over-the-counter medicine to which he is not allergic (Tylenol®, Advil® or other ibuprofen product). Upon follow up in the office, we will examine the hole to ensure that it stayed open. The sutures (if any were placed) are self-dissolving, and do not require removal. In the first two to three days, you may be asked to spread antibiotic ointment (i.e. Bacitracin®) on the area to prevent the sutures or skin from sticking to diapers or undergarments. The ointment may also help to prevent recurrence. Some surgeons may ask you to put your son into a warm bath a couple of times a day. Some may ask you to gently spread the hole apart a few times a day for the first few days to help prevent the edges from sticking together.
Expectations of Outcome
You should notice that your child's urine stream is no longer spraying or deflected upward. Again , he may have discomfort the first few times that he urinates. Encourage him not to hold the urine back. Sometimes, placing him into a warm tub to urinate will be helpful.
Most meatotomies do stay open. There is a small chance that the opening can scar down and need to be re-opened. We often make the meatus wider than is necessary for a successful outcome because we know and expect that a small length of the cut tissue will scar closed. There may be some swelling that may make the penis appear curved or wide. This swelling will disappear over the next one to two weeks.
The sutures (if placed) will break and fall out on their own in one to three weeks. If a suture breaks early (that day or within a couple of days), you need not be concerned. Chances are it has already served its purpose.
Possible Complications of the Procedure ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may generate questions if you are still concerned. Aside from anesthesia complications, it is important that parents be made aware of all possible outcomes which may include, but are not limited to:
- Recurrent Meatal Stenosis: Again, despite a wide open meatus, some will re-close and perhaps require another procedure.
- Infection: Infection is quite unusual following meatotomy, but is possible in any procedure. Usually, local wound care and antibiotics are sufficient.
- Penile or Urethral Injury
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.
Delta Medix, P.C.