Question Title: Is there a cure for meatal stenosis?

Posted by A.M. (INDIA) on April 21, 1999 at 11:24:12

Dear doctor,
I’m a 24yr old male who was diagnosed as having submeatal stenosis on 25th Dec 1996. I live in India and now realize that there are quite a few people who suffer from this same condition. I was circumcised at the age of 11 as the foreskin would not pull back and it had reached an extreme state where the tip actually burst due to pressure while urinating. Everything was normal after that till I was in college; I had an STD (Gonorrhea). I seem to have suffered with it for at least 8 months before I was cured. My stream of urine had narrowed during the STD period and had improved after the cure. In Oct ’94 I had an operation to correct a hernia on the left side just below the abdomen (my left testicle has since become smaller and has no sensation). A few months later I had felt difficulty in urinating, and saw blood in the few drops that remain in the end. This lasted just for a day; I saw a urologist and he could not diagnose the cause, but had put me on antibiotics for a suspected infection. Gradually 6 months prior to 25th Dec ’96, I realized that the opening at the tip of my penis was getting smaller, and it took longer to urinate. On the 24th night I felt pain while trying to urinate (much more than what I had usually experienced) and saw blood in the drops that came out. I had decided to go meet a doctor the next day but at night it grew worse and had to get admitted. Ever since I’ve been dilating using a catheter (initially 14french and now 12 french), daily once in the morning. It starts getting blocked even if I stop for a day. I have read through all the other letters posted here and have come across a few that are very similar to mine. However there are a few questions I would like to ask in order to get a second opinion.

1) My doctor says that the frequency of dilatation should come down over a period of time. Can I ever get back to normal and stop using the catheter (dilating)?
2) When I dilate using size 14 french the stream of urine gets better, what is the correct size to use and is it harmful to use a thicker size against the pain?
3) I have a normal sex life but will this condition affect my chances of becoming a father?
4) My left testicle is small, has something gone wrong? Isn’t that abnormal?
5) I know that I’m not alone but how many people are actually out there with this problem?

I would be extremely grateful if you could reply to these questions. Please do let me know if there is someplace I could get more material on this subject and if there is someone like me I could talk to.
Thank you very much for all the help
A.M. (INDIA)

---

Posted by HFHS M.D.-BE on April 25, 1999 at 21:53:34

---

=

---

Dear A.M.,
Given your history of gonorrhea, it is possible that you have urethral stricture (narrowing) at more locations than just the meatus. The meatal stenosis, however, appears to be your primary complaint. It is possible to treat meatal stenosis with a procedure called meatoplasty. This is a simple and often effective procedure. Meatoplasty is usually performed on the pediatric population, since meatal stenosis is a common side effect of circumcision. You have asked specific questions, whose answers are:
The need for dilation should become progressively less, provided that you do not have an interim infection or other trauma leading to inflammation and further scarring. It is possible to get back to almost normal if your meatal stenosis could be repaired surgically (meatoplasty).
The usual caliber for the meatus is an 18 -20 french for an adult male. A 14 french opening is not large enough to accommodate an adequate urine flow and complete emptying of the bladder, in an adult male. The opening should be dilated up to a 20-22 french by a urologist, probably using some sedation. After this initial dilation, it is your task to continue to dilate to maintain the caliber opening.
Meatal stenosis in and of itself should have no deleterious effect on your ability to father a child, provided that all the ejaculate (semen) comes out.
You say that your left testicle changed in size following the hernia repair. A smaller testicle could be less functional. You need to follow up with your urologist about this particular issue.
It is hard to say how many men may be suffering from meatal stenosis. It is not an uncommon problem with someone with a history like the one you present. It also could develop in patients who have been catheterized for different reasons.

You say that you are now having pain and blood in your urine. All your symptoms, and certainly your increasing urethral stricture, would point to your need for a thorough evaluation as soon as possible with a urologist who can best offer a plan of treatment.

This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-BE
*keyword: meatal stenosis

---