| 词条 | Meatal stenosis |
| 释义 |
| name = Urethral meatal stenosis | image = | caption = | | pronounce = | field = urology | synonyms = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} Urethral meatal stenosis or urethral stricture is a narrowing (stenosis) of the opening of the urethra at the external meatus {{IPAc-en|m|iː|ˈ|eɪ|t|ə|s}}, thus constricting the opening through which urine leaves the body from the urinary bladder. Symptoms
CausesThe protection provided by the foreskin for the glans penis and meatus has been recognized since 1915. In the absence of the foreskin the meatus is exposed to mechanical and chemical irritation from ammoniacal diaper (nappie) that produces blister formation and ulceration of the urethral opening, which eventually gives rise to meatal stenosis (a narrowing of the opening).[1] Meatal stenosis may also be caused by ischemia resulting from damage to the frenular artery during circumcision.[1][2] RiskFrisch & Simonsen (2016) carried out a very large-scale study in Denmark, which compared the incidence of meatal stenosis in Muslim males (mostly circumcised) with the incidence of meatal stenosis in ethnic Danish males (mostly non-circumcised). The risk of meatal stenosis in circumcised males was found to be as much 3.7 times higher than in the non-circumcised males.[1] DiagnosisIn boys, history and physical exam is adequate to make the diagnosis. In girls, VCUG (voiding cystourethrogram) is usually diagnostic. Other tests may include:
PreventionIn the newbornAccording to Frisch & Simonsen (2016), "the foreskin is protective against urinary stricture disease" (meatal stenosis).[1] Frisch & Simonsen (2016) call for a "thorough reassessment of the burden of urethral troubles and other adverse outcomes after non-therapeutic circumcision of boys."[1] Saeedi et al. (2017) propose long-term follow-up of circumcision with ultrasonography "to detect meatal stenosis before permanent renal damage occurs."[3] After hypospadias repairMeir & Livne (2004) suggest that use of a broad spectrum antibiotic after hypospadias repair will "probably reduce meatal stenosis [rates]",[4] while Jayanthi (2003) recommends the use of a modified Snodgrass hypospadias repair.[5] TreatmentIn females, meatal stenosis can usually be treated in the physician's office using local anesthesia to numb the area and dilating (widening) the urethral opening with special instruments. In boys, it is treated by a second surgical procedure called meatotomy in which the meatus is crushed with a straight mosquito hemostat and then divided with fine-tipped scissors.[10] Recently, home-dilatation has been shown to be a successful treatment for most boys.[6] PrognosisMost people can expect normal urination after treatment.[10] IncidenceNumerous studies over a long period of time clearly indicate that male circumcision contributes to the development of urethral stricture. Among circumcised males, reported incidence of meatal stricture varies. Griffiths et al. (1985) reported an incidence of 2.8 percent.[7] Sörensen & Sörensen (1988) reported 0 percent.[8] Cathcart et al. (2006) reported an incidence of 0.55 percent.[9] Yegane et al. (2006) reported an incidence of 0.9 percent.[10] Van Howe (2006) reported an incidence of 7.29 percent.[11] In Van Howe's study, all cases of meatal stenosis were among circumcised boys. Simforoosh et al. (2010) reported an incidence of 0.55 percent. [12] According to Emedicine (2016), the incidence of meatal stenosis runs from 9 to 20 percent.[13] Frisch & Simonsen (2016) placed the incidence at 5 to 20 percent of circumcised boys.[1] References1. ^1 2 3 4 5 {{vcite journal | author=Frisch M, Simonsen | title=Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977e2013 | journal=The Surgeon | date=2016 | volume= | issue= | pages= | url= http://www.thesurgeon.net/article/S1479-666X(16)30179-2/pdf | doi= 10.1016/j.surge.2016.11.002 | pmid=28017691 | pmc= }} Epublished ahead of print on 22 December 2016. 2. ^{{vcite journal | author= Van Howe RS |year=2006 |title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting |journal=Clin Pediatr (Phila) |volume=45 |issue=1 |pages=49–54 |pmid=16429216 |doi=10.1177/000992280604500108}} 3. ^{{vcite journal | author=Saeedi P, Ahmadnia H, Akhavan Rezayat A | title=Evaluation of the effect of meatal stenosis on the urinary tract by using ultrasonography | journal= Urol J | date= 2017 | volume= 14 | issue= 3 | pages=3071–3074 | url=http://www.urologyjournal.org/index.php/uj/article/viewFile/3866/1247 | doi=10.22037/uj.v14i3.3866 | pmid= 28537045 | pmc= }} 4. ^{{vcite journal | author = Meir DB, Livne PM |date=June 2004 |title=Is prophylactic antimicrobial treatment necessary after hypospadias repair? |journal=The Journal of Urology |volume=171 |issue=6 part 2 |pages=2621–2622 |pmid=15118434 |url= |accessdate= |quote= |doi=10.1097/01.ju.0000124007.55430.d3 }} 5. ^{{vcite journal | author = Jayanth VR |date=October 2003 |title=The modified Snodgrass hypospadias repair: reducing the risk of fistula and meatal stenosis |journal=The Journal of Urology |volume=170 |issue=4 part 2 |pages=1603–1605; discussion 1605 |pmid=14501672 |url= |accessdate= |quote= |doi=10.1097/01.ju.0000085260.52825.73 }} 6. ^{{vcite journal | author =Searles JM, MacKinnon AE |date=March 2004 |title=Home-dilatation of the urethral meatus in boys |journal=BJU Int |volume=93 |issue=4 |pages=596–597 |pmid=15008738 |url= |accessdate= |quote= |doi=10.1111/j.1464-410X.2003.04680.x }} 7. ^{{vcite journal | author=Griffiths DM, Atwell JD, Freeman NV |year=1985 |title=A prospective survey of the indications and morbidity of circumcision in children |journal=Eur Urol |volume=11 |issue=3 |pages=184–7 |pmid=4029234 |doi=10.1159/000472487}} 8. ^{{vcite journal |authors=Sörensen SM, Sörensen MR |title=Circumcision with the Plastibell device. A long-term follow-up |journal=Int Urol Nephrol |volume=20 |issue=2 |pages=159–66 |year=1988 |pmid=3384610 |doi= 10.1007/BF02550667|url=}} 9. ^{{vcite journal |authors=Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE |title=Trends in paediatric circumcision and its complications in England between 1997 and 2003 |journal=Br J Surg |volume=93 |issue=7 |pages=885–90 |date=July 2006 |pmid=16673355 |doi=10.1002/bjs.5369 |url=}} 10. ^{{vcite journal |author=Yegane RA, Kheirollahi AR, Salehi NA, et al |date=May 2006 |title=Late complications of circumcision in Iran |journal=Pediatr Surg Int |volume=22 |issue=5 |pages=442–445 |pmid=16649052 |url= |accessdate= |quote= |doi=10.1007/s00383-006-1672-1 }} 11. ^{{vcite journal | author= Van Howe RS |year=2006 |title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting |journal=Clin Pediatr (Phila) |volume=45 |issue=1 |pages=49–54 |pmid=16429216 |doi=10.1177/000992280604500108}} 12. ^{{vcite journal |authors=Simforoosh N, Tabibi A, Khalili SA, et al |title=Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell |journal=J Pediatr Urol |volume= 8|issue= 3|pages= 320–3|date=November 2010 |pmid=21115400 |doi=10.1016/j.jpurol.2010.10.008 |url=}} 13. ^1 2 {{vcite web |author= Koenig JF | home=EMedicine | title=Meatal stenosis | url=http://emedicine.medscape.com/article/1016016-overview | date=22 September 2016 | accessdate=21 August 2017}} External links{{Medical resources| ICD10 = | ICD9 = {{ICD9|598.9}} | ICDO = | OMIM = | DiseasesDB = 13562 | MedlinePlus = 001599 | eMedicineSubj = | eMedicineTopic = | MeshID = D014525 }}{{Urologic disease}}{{DEFAULTSORT:Meatal Stenosis}} 1 : Urethra disorders |
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