Department of Visceral Surgery, Children's Hospital Canastel, Faculty of Medicine, University of Oran, Algeria.
Department of Visceral Surgery, Children's Hospital Canastel, Faculty of Medicine, University of Oran, Algeria.
J Pediatr Urol. 2022 Feb;18(1):89.e1-89.e6. doi: 10.1016/j.jpurol.2021.10.008. Epub 2021 Oct 20.
The prevalence of meatal stenosis after circumcision remains unclear, and its causes are unknown.
To know the prevalence and the causes of meatal stenosis after circumcision in boys.
Between October 2018 and April 2019, we carried out a prospective cross-sectional study on 1031 circumcised boys, aged 5-8 years (mean age 6.1 years ± 0.3 years), enrolled in the first level of primary school. All enrolled children underwent genitourinary examination. Moreover, an anonymous questionnaire was filled-in by one of the parents.
The screening revealed the presence of meatal stenosis in 185 children, representing a prevalence of 17.9% of cases (95% CI = 15.6-20.3). Analysis of the results using both the univariate and multivariate mode brought out some common risk factors such as a foreskin that completely adheres to the glans with forceful retraction of the prepuce and the use of a healing product: Beta-sitosterol and Hydrocotyl (Centella Asiatica), rarely Trolamine. In addition, this study showed that boys circumcised during their first week of life are twice as likely to develop meatal stenosis than those circumcised between 7 and 12 months (OR = 2.08; 95% CI = 1.10-3.92, p = 0.021).
We believe that when the foreskin is fully attached to the glans, forced retraction of the prepuce most often causes a loss of the mucous membrane that covers the glans, making the glans less resistant to chemical attack, and therefore may play an important role in the development of meatal stenosis. However, This study is limited by the absence of a cohort of uncircumcised boys for comparison to see if the small diameter of the meatus is also present in this group.
This study showed that stenosis of the urethral meatus is a frequent complication of circumcision. Circumcision in the first week of life, complete adhesion of the foreskin to the glans, and the use of a healing product were associated with the risk of stenosis development.
割礼后尿道口狭窄的发生率尚不清楚，其病因也不清楚。
了解男孩割礼后尿道口狭窄的发生率及病因。
2018 年 10 月至 2019 年 4 月，我们对 1031 名 5-8 岁（平均年龄 6.1 岁±0.3 岁）入读小学一年级的割礼男孩进行了前瞻性横断面研究。所有入组儿童均行泌尿生殖系统检查。此外，由一位家长填写匿名问卷。
筛查发现 185 名儿童存在尿道口狭窄，发生率为 17.9%（95%可信区间为 15.6-20.3）。单因素和多因素分析均发现一些共同的危险因素，如包皮与龟头完全粘连，强行向后牵拉包皮，使用愈合产品：β-谷甾醇和 Hydrocotyl（积雪草），很少使用 Trolamine。此外，本研究还表明，出生后第一周行割礼的男孩发生尿道口狭窄的风险是出生后 7-12 个月行割礼的男孩的两倍（OR=2.08；95%可信区间为 1.10-3.92，p=0.021）。
我们认为，当包皮完全附着于龟头时，强行向后牵拉包皮，最常导致覆盖龟头的黏膜丧失，使龟头对化学物质的抵抗力降低，因此可能在尿道口狭窄的发生中起重要作用。然而，本研究受到限制，因为缺乏未行割礼的男孩队列进行比较，以观察尿道口狭窄是否也存在于这一组。
本研究表明，尿道狭窄是割礼后的常见并发症。出生后第一周行割礼、包皮与龟头完全粘连、使用愈合产品与狭窄发生风险相关。
