Introduction: Meatal stenos is almost always develops following neonatal circumcision, and it usually does not become apparent until the child is toilet trained.The present study was conducted to determine the value of diagnostic ultrasonography in patients with meatal stenosis.Materials and Methods: A descriptive study was performed on 120 patients with meatal stenosis, referred to Naghavi Hospital, Kashan, Iran, from July 2000 to March 2002. Symptoms and findings on physical examination were recorded for every patient, ultrasonography of the urinary tract, and urinalysis and urine culture were also performed.Results: Mean age of the patients was 2.5 years (range, 3 months to 6 years). The common symptoms were dysuria (35%), decreased urine caliber (33.3%), and bloody spotting (15%), while 26.6% of the patients were asymptomatic. Paraclinical findings were microscopic hematuria (17.5%), bacteriuria (1.6%), and ureteral duplication (0.8%). No case of obstructive uropathy was detected by ultrasonography.Conclusion: Meatal stenosis rarely causes obstructive uropathy. Hence, urinary tract ultrasonography is rarely necessary, unless symptoms persist after meatotomy.

Introduction: In our country meatal stenosis due to early circumcision is common. Long lasting meatal stenosis may cause bladder outlet obstruction. The aim of this study is to evaluate the effect of meatal stenosis on lower and upper urinary tract using ultrasonography.Methods: From 2008 to 2011, forty two boys (age 2 to 8 years) suffered from meatal stenosis were enrolled in this study. Diagnosis of meatal stenosis and its severity were confirmed by Nelaton catheter in all cases. Documented subjects were referred for urinary tract ultrasonography. Hydronephrosis, hydroureter, bladder wall thickness in full and empty bladder, bladder volume and residual urine were evaluated by ultrasonography.Results: Meatal stenosis was confirmed in 42 subjects. Thirty seven subjects (88%) had normal upper urinary tract ultrasonography. Five cases (12%) showed bilateral hydronephrosis. In 35 subjects (83%) bladder wall thickness was increased and 30 cases (60%) had high residual urine (more than 20% of bladder volume).Conclusion: Long term meatal stenosis could induce bladder wall thickness and increase residual urine. Early correction of meatal stenosis can prevent these urinary complications.

Introduction: To determine the incidence of meatal stenosis after neonatal circumcision.Methods: Male children who had been circumcised during the Neonatal period and presented at our pediatric clinic for reasons other than urinary complaints were examined and interviewed regarding urination problems.Results: Of the 132 cases, 27 (20.4%) had severe meatal stenosis (diameter < 5 F). Thickening of the bladder and bilateral hydronephrosis (pyelocaliceal) were found in three cases (11.1%), and a voiding cystourethrogram was performed to reveal vesicoureteral reflux (VUR). One patient had grade II VUR in his right kidney and grade III in his left kidney; another had grade II VUR in both kidneys.Conclusion: These results highlight the importance of follow-up genital examination for all male children who have been circumcised during the neonatal period, to detect possible meatal stenosis.

Meatal stenosis (MS) is known as one of the most frequent complications of circumcision. In the present study, we aimed to find any possible relationship between MS and allergic disorders. A total of 36 children with a mean±, SD age of 5. 84±, 2. 03 years were referred with MS and an atopic background even in themselves or in one of their family members (Group A). There were also age-matched controls with a mean±, SD age of 5. 70±, 2. 17 years who were referred to our center with allergic symptoms and no urinary complaints (Group B, n=17). The RIDA qLine allergy and allergy explorer (ALEX) tests were performed for all patients to find possible allergen sensitization. Laboratory findings revealed that IgE-sensitization to the main food and aeroallergens in Group A (with the chief complaint of MS in whom a mild atopic condition was found during concise medical history taking) were very similar to the control group with no significant difference (except for ryegrass which was higher in the control group). Although total IgE level was considerably higher in group B compared to group A, food sensitization to cow’, s milk and ß,-lactoglobulin was higher in asthmatic patients of group A compared to the controls. It seems that not all patients with MS should be considered as a complication of circumcision and undergo a surgical procedure for correction of the stenosis. Further investigations are required to determine the role of concise medical history taking and proper treatment of the allergic disorder to reduce failed surgical attempts in atopic boys with MS.

Introduction: Meatal stenosis is a late complication of circumcision. Objectives: This study was designed to determine its prevalence, its relationship with age of circumcision and its applied method. Material and Methods: This prospective study was conducted between December 2006 and January 2012. A total of 2389 boys, equal to or less than 6 years were circumcised using the Plastibell device (PD) or conventional dissection surgery (CDS). They followed up 12 months after surgery. Signs and symptoms of meatal stenosis recorded and the meatus evaluated for stenosis. Results: Meatal stenosis was diagnosed in 41 boys (1. 7%). Twenty-five of patients were asymptomatic (61%). The difference between the mean age of circumcision in patients with meatal stenosis and the others were statistically significant. In newborns the prevalence of meatal stenosis was more than the other ages (15% versus 1. 4%, P < 0. 01). Concerning the method of circumcision, a significant difference on the prevalence of meatal stenosis was detected too (0. 8% in PD versus 3. 6% in CDS; P < 0. 001). The mean interval between circumcision and diagnosis of meatal stenosis was 9. 59 months. Conclusion: Symptomatic presentation of meatal stenosis may be late and it needs long-term follow-up. Its prevalence is higher in younger boys. Thus, circumcision in younger boys, especially in neonates is not recommended. Using PD has lower rate of meatal stenosis in comparison to CDS. Hence, the result of this study showed, the PD is preferable in younger boys.

Purpose: Circumcision is one of the oldest surgical procedures that originated for religious purposes. Circumcision in infancy is a common procedure in our country and secondary meatal stenosis due to circumcision is a common complication. The aim of our study is to determine the effect of meatal stenosis on the lower and upper urinary tract of circumcised boys by using ultrasonography. Materials and Methods: In this cross-sectional study, we enrolled 87 circumcised boys between 4 to 8 years old with severe meatal stenosis. Clinical findings of our subjects were gathered by a checklist that included: thin stream of urine, upward urine stream deviation, infrequent voiding, urinary tract infections, voiding dysfunction, and urge incontinency. In lab data analysis, complete blood cell count (CBC), urine analysis, urine culture, blood urea nitrogen (BUN), and plasma creatinine level were evaluated. Ultrasonography detected hydronephrosis, hydroureter, bladder wall thickening in a full and empty bladder, bladder volume, and residual urine volume. Result: Narrowing of urine stream is commonly seen (about 54%) among patients with severe meatal stenosis, and similarly in sonographic evaluations the most common symptoms among patients was thickening of the bladder wall that increased in an empty and a full bladder (about 82%). Conclusion: The author of this study recommends performing long-term follow up after circumcision and ultrasonography to detect meatal stenosis before permanent renal damage occurs.

Background: Meatal stenosis is of common late complication of neonatal circumcision, albeit the appropriate post-operative care and conventional consumption of topical agents such as tetracycline. Nevertheless, its underlying etiology still remained vague. Lack of protective effects of foreskin and subsequent inflammation reaction due to chemical and mechanical irritation is thought to be the most probable cause. Materials and Methods: A retrospective review of the medical records of the male neonates, were considered eligible who referred to our pediatric tertiary center (Hazrat-e-Masumeh hospital, Qom city) for circumcision between May 2014 and April 2016. Neonates with severe phimosis and buried penis were excluded from the study. Based on the medical records the patients were divided into two groups. Patients were operated similarly, and then, those who received 1% hydrocortisone ointment post-operatively (n=91) and those who received the conventional treatment with tetracycline cream instead of hydrocortisone (n=91). Results: The mean age of neonates was 19. 2 ± 3. 6 and 21. 4 ± 2. 1 days for tetracycline and hydrocortisone groups, respectively. Meatal stenosis has occurred in 27(29. 67%) patients of the tetracycline group, and 11(12. 08%) of the hydrocortisone group (P=0. 008). Mean time to develop meatal stenosis in the tetracycline group was less than that of the hydrocortisone group (2. 3 ± 0. 4 vs. 3. 8 ± 0. 65 weeks, respectively, P=0. 03). There was no adverse effect associated with application of 1% topical ointment of hydrocortisone. Conclusion According to the results, applying the topical ointment of hydrocortisone can more effectively reduce post-circumcision meatal stenosis compared with tetracycline cream. Nonetheless, conducting further investigations designing as randomized clinical trial or experimental studies is highly encouraged.

This study presents initial experience in endoscopic meatal dilatation of obstructive ureterocele in adult patients. During cystourethroscopy, we tried to find the orifice of ureterocele, passed a guide wire and introduce an 8 Fr ureteroscope in to the ureterocele orifice, going up to the renal pelvis as under vision dilatation of ureterocele meatus. Two Double-J stent were inserted and remained for six weeks to keep the meatus dilated. Adverse effect of endoscopic management was decreased due to minimal anatomic changes. Patients’ symptoms were relieved and no evidence of new onset vesico-ureteral reflux and obstruction were seen after up to one-year follow-up. Endoscopic meatal dilatation of stenotic ureterocele in adult patients is safe and effective thus, trying to find the orifice of ureterocele is suggested.

Purpose: Meatal stenosis is still a common problem in tubularized incised plate urethroplasty. In this study, we aimed to seek for a relationship between the size of urethral catheter and meatal stenosis formation in children undergoing tubularized incised plate urethroplasty. Materials and Methods: We retrospectively reviewed 83 children who underwent tubularized incised plate urethroplasty for hypospadias. The whole group was classified into the groups A and B based on the catheter size. One group (group A) consisted of 44 patients (mean age, 4. 82 ± 3. 83 years) with tubularized neourethra over a 6 Fr catheter, while the other group (group B) included 39 patients (mean age, 5. 19 ± 3. 83 years) with tubularized neourethra over a 8 Fr catheter. Results: There were no significant differences between the groups according to their age, location of urethral meatus, dehiscence and urethrocutaneous fistula formation. Meatal stenosis formation in group B was markedly higher than that in group A. Number of meatal dilatation was higher in group B compared to group A. Conclusion: We suggest that the tubularization of urethral plate over a small-sized (6 Fr) catheter, regardless of the age of the patients, prevents meatal stenosis by reducing foreign body reaction and pressure injury and by hindering secondary healing.

Introduction: Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis. Materials and Methods: A randomized control trial was performed, in which 2 groups of boys younger the 2 years old underwent circumcision according to the sleeve method. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time. Results: A total of 197 boys in each group completed the study. None of the children in the study group but 13 (6.6%) in the control group developed meatal stenosis (P<.001). Infection of the circumcision site was seen in 3 (1.5%) and 23 (11.7%) children of the lubricant and control groups, respectively (P<.001), and bleeding was seen in 6 (3.0%) and 37 (18.8%), respectively (P<.001). The mean time of recovery in the lubricant group was 3.8±1.2 days, while it was 6.9±4.2 days in the control group (P=.03).Conclusion: Based on the findings of this study, it seems logical to use a lubricant jelly for reducing postcircumcision meatal stenosis and other complications.