Surgical treatment of Meatal Stenosis. Lessons learned from the pediatric Urology practice.
David Dothan, MD, Yehuda Noyman, MD, Dolev Perez, MD, Stanislav Kocherov, MD, Jawdat Jaber, MD, Boris Chertin, MD.
Shaare Zedek Medical Center, Jerusalem, Israel.
BACKGROUND: Urethral Meatotomy/Meatoplasty as treatment for Meatal stenosis is a common pediatric urology procedure, creating a high economic burden in the common practice of pediatric urologists. Therefore we aimed to evaluate the indications for surgery and outcome of Meatotomy and Meatoplasty in a big cohort of children who required surgical correction of Meatal stenosis.
METHODS: We have retrospectively evaluated 2211 children who underwent either Meatotomy or Meatoplasty in our institute between 2009-2020 utilizing the same operative setup.
RESULTS: Of 2211 children, 1906 underwent Meatotomy and 305 Meatoplasty respectively. The decision regarding the type of surgery was executed by the surgeon in the operative theater. The mean age was 5 years (range: 1 month-15 years) and there was no age difference between the two groups. There was no difference between the duration of surgery, recovery time or complication rates between the two groups. Muslim ethnicity was a significant predictor for undergoing Meatoplasty. Deviated stream was the most frequent indication for treatment 1477 (67%). On Univariate logistic regression children with the following indications for surgery: dysuria, meatitis and urinary retention had increased odds toward Meatoplasty, while the indication of deviated stream had increased odds toward Meatotomy. On Multivariate Logistic regression only deviated stream (Odd ratios 1.47, P 0.005) and urinary retention (Odds ratio 4.5, P 0.027) remained significant predictive factors for Meatotomy and Meatoplasty respectively. Eleven (0.58%) children who underwent Meatotomy developed recurrent Meatal stenosis and underwent another surgery, of those, seven needed Meatoplasty and four had Meatotomy. None of the children who underwent Meatoplasty needed reoperation. Sixty-nine children (3.6%) after Meatotomy required manual opening of the meatus on the first post-operative visit due to lack of regular spreading of the neomeatal edges in the immediate postoperative period.
CONCLUSIONS: Our data shows that specific indications for the treatment of Meatal stenosis may predict the type of surgery. Meatotomy had a higher reoperation rate and frequently required manual meatal spreading in the early postoperative period. We believe that Meatoplasty is a preferable surgery for children with Meatal stenosis.
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