Assessment of meatal stenosis in neonates undergoing circumcision using Plastibell Device with two different techniques

Comparison the Diameter of the Urethral Meatus Before and After Circumcision and Evaluation of Urethral Stenosis

Objectives. This study focused on assessing the diameter of the meatus before and after circumcision to evaluate meatal stenosis. Methods. In this cross-sectional study, boys who met the inclusion criteria, their demographic parameters, and meatus diameter were recorded. Thirty days after circumcision, complications were evaluated meatus diameter was measured again and their information was analyzed by SPSS 26 software. Results. Four hundred boys were studied, and it was found that 41 cases (10.3%) developed meatal stenosis after circumcision, with 85% having a pre-circumcision meatus diameter of 4 mm or less. Statistical analysis revealed a significant correlation (P < .05) between smaller pre-circumcision meatus diameter and postoperative meatal stenosis. Conclusions. The study concludes that a smaller meatus diameter before circumcision significantly increases the risk of postoperative tightness. It suggests prophylactic measures like meatus dilatation or applying topical ointment for those at high risk (meatus diameter ≤ 4 mm) to prevent or mitigate postoperative meatal stenosis.

Meatal stenosis following three types of circumcision with frenular artery preservation (FAP), the Plastibell device (PD), and frenular artery ligation (FAL): a long-term follow-up

BACKGROUND

Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions.

AIM

This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device.

METHODS

This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11 years (range, 7-17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis.

RESULTS

Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P = 0.026).

CONCLUSION

The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.

Optimal clamping time in meatotomy procedure for children with meatal stenosis: Experience with 120 cases

OBJECTIVE

During meatotomy procedure for children with meatal stenosis (MS), a straight clamp used as a hemostat on the ventrum of the meatus before incised with scissors for clamping and holding bleeding from the site of operation. The aim of this study was to evaluate the optimum clamping time for meatotomy in children with MS.

MATERIALS AND METHODS

All the patients with MS between 2014 to 2019 were enrolled in this retrospective study. Patients with uncircumcised penis, traumatic catheterization, any kind of penile abnormality such as hypospadias or penile curvature, and active urinary tract infection (UTI) were excluded. The indication of meatotomy was a pinpoint meatus that develops with dorsal or lateral deflection of the urinary stream and high-velocity urine flow. During meatotomy procedure, clamping time was examined in different groups such as 2, 3, and 4 minutes. The main symptoms of presentation and ultrasonography (US) findings were recorded and compared between groups. To assess the optimum time clamping, postoperative bleeding was noted carefully in all groups. The success rate was recorded at onemonth postoperative follow-up in the clinic.

RESULTS

Of the 120 patients with MS who underwent a meatotomy procedure, there were 40 (33.3%) participants in each group. The main symptoms were painful urination and urine stream deviation that represented in 54 (46%) patients. Bladder wall thickness was the main pre-operation finding in the US which was observed in 67 (55.8%) patients. In comparison between the groups related to clamping time, bleeding was observed and required suturing when clamping was applied for 2 minutes in 4 (3.3%) patients (p = 0.016). With a minimum follow-up of 12 months, no recurrent meatal stenosis was reported.

CONCLUSIONS

Clamping time for more than 2 minutes may prevent bleeding during and after meatotomy.