Department of Pediatric Surgery, Koç University Hospital, Istanbul, Turkey.
Department of Pediatric Nephrology, Koç University Hospital, Istanbul, Turkey.
J Pediatr Urol. 2017 Dec;13(6):617.e1-617.e4. doi: 10.1016/j.jpurol.2017.05.007. Epub 2017 Jun 2.
Meatal stenosis (MS) is a known complication of newborn circumcision. Symptoms are usually masked in young kids with a diaper. Deflation of urinary stream, dysuria, urinary frequency, and incontinence are the most common reported symptoms. Diagnosis of MS is still controversial. A narrow pinpoint urethral meatus is the current accepted diagnostic criteria.
In our practice, we observed that our cases do not overlap to the classic definition and presentation of MS. In this study, we presented our cases and aimed to share our observations.
Records of children who had meatoplasty between 2014 with 2016 were analyzed retrospectively. Only children with MS who had had newborn circumcision performed in our clinic were included in the study. Over 500 newborn circumcisions are performed per year in our clinic using the Gomco Clamp technique. Age at diagnosis, presenting complaints, penile anomalies including urethral meatus configuration, urinary symptoms, operation methods, and postoperative follow-up were gathered.
A total of 13 boys who were circumcised in the newborn period had undergone meatoplasty with the diagnosis of MS. The mean age at the time of meatoplasty was 52.5 ± 17.9 (range 37-93 months). All children were examined before and during the circumcision. There were no associated penile anomalies, including MS. The only presenting complaint was upward deflation of urinary stream instead of other lower urinary tract symptoms. Although the appearance of the meatus was pinpoint in all cases (Figure); it was easy to calibrate with an 8-10 Fr feeding tube. There was no stenosis, but a ventral web was detected. Meatoplasty with removal of this web was performed under general anesthesia. Two sutures were applied at 5 and 7 o'clock with 7/0 PDS. Mean postoperative follow-up time was 16.9 ± 7.5 months. Children were pleased with direction of urinary stream.
Both the diagnosis and morphological definition of MS have some controversies. To our knowledge, there is no similar reported study with pinpoint appearance and normal calibration of the meatus. There was no stenosis in any of them. Unlike classical MS presentations, upward deflation of urinary stream resulting from ventral web was a single presenting complaint.
Upward deflation of urinary stream can develop after neonatal circumcision because of a meatal web without stenosis, and can be cured easily with meatoplasty. Instead of 'meatal stenosis', 'meatal web' may be a more appropriate term to explain the pathology in these patients.
尿道外口狭窄（MS）是新生儿包皮环切术的已知并发症。在有尿布的幼儿中，症状通常被掩盖。尿流变细、排尿困难、尿频和尿失禁是最常见的报告症状。MS 的诊断仍存在争议。目前公认的诊断标准是尿道外口呈针尖状狭窄。
在我们的实践中，我们观察到我们的病例与 MS 的典型定义和表现并不完全吻合。在这项研究中，我们介绍了我们的病例，并旨在分享我们的观察结果。
回顾性分析了 2014 年至 2016 年间行尿道成形术的儿童的病历。仅纳入在我们诊所接受过包皮环切术且诊断为 MS 的儿童。我们诊所每年有 500 多名新生儿接受 Gomco 夹技术的包皮环切术。收集了年龄、临床表现、阴茎异常，包括尿道外口形态、排尿症状、手术方法和术后随访等信息。
共有 13 名男孩在新生儿期接受了包皮环切术，并被诊断为 MS。行尿道成形术时的平均年龄为 52.5±17.9 岁（范围 37-93 个月）。所有儿童在包皮环切术前和术中均接受了检查。没有其他阴茎异常，包括 MS。唯一的表现是尿流向上变细，而没有其他下尿路症状。尽管所有病例的尿道外口均呈针尖状（图），但很容易用 8-10Fr 喂养管校准。没有狭窄，但发现了一个腹侧的网。在全身麻醉下，通过切除该网进行尿道成形术。在 5 点和 7 点位置用 7/0 PDS 缝线缝合 2 针。术后平均随访时间为 16.9±7.5 个月。患儿对尿流方向满意。
MS 的诊断和形态学定义存在一些争议。据我们所知，目前尚无类似的研究报道，即针尖状外观和尿道外口正常校准。它们均无狭窄。与经典 MS 表现不同，由于腹侧网导致的尿流向上变细是唯一的表现。
新生儿包皮环切术后，由于尿道外口有网而没有狭窄，可能会出现尿流向上变细，通过尿道成形术可轻松治愈。与“尿道外口狭窄”相比，“尿道外口网”可能是更能解释这些患者病理的术语。
