Eversion meatoplasty in management of urethral meatal stenosis

Abstract

Urethral meatal stenosis is common, producing about 5 per cent of all new patients in paediatric urologist office [1]. It may be congenital or acquired. The acquired type can follow repeated urinary tract infection or urethral instrumentation. Herein we present an eversion meatoplasty which is a simple technique that can be done even under local infiltration anaesthesia especially in children older than 10 years. This technique was applied in 100 cases. The results were excellent, apart from urinary spraying in the first few days that was noticed in 13 cases and disappeared spontaneously. Restenosis was not encountered in any of our cases.

Application of Dorsal Preputial Island Flap in Meatoplasty

“…Better results may be achieved with skin inversion [4] or eversion meatoplasty [7] that give a 'hypospadic' appearance to the urethral meatus. Very good functional and morphological results can be accomplished with transposition of skin grafts [8] or buccal mucosa [9,10] , but Jordan's ventral transverse island flap procedure proved to be the ideal method [11] .…”

Wedge meatoplasty as a treatment for stricture of the urethral meatus in a cat

“…20 Sounding was considered inappropriate in this case as repeated sedation or general anaesthesia would be required and because of concern that the apparent fibrosis around the meatus would limit its effectiveness. Various meatoplasty techniques have been used for treatment of meatal stricture in humans including ventral transverse island fasiculocutaneous penile flap 21 , dorsal and ventral meatotomy with a v-shaped relieving incision, 22 eversion meatoplasty, 23 resection and primary end-to-end anastomosis, 24 meatoplasty with double buccal mucosa grafts, 25 or a dorsal preputial island flap 26 and meatoplasty with various other local skin flaps or free skin grafting. 11 Here, a simple wedge meatoplasty similar to the eversion meatoplasty described by el-Kasaby et al 23 and the Mathieu and a V incision sutured (MAVIS) modification of the Mathieu technique for hypospadias repair 27 was used: more complicated techniques involving flaps or grafts were considered inappropriate because of the small diameter of the cat's urethra.…”

“…Various meatoplasty techniques have been used for treatment of meatal stricture in humans including ventral transverse island fasiculocutaneous penile flap 21 , dorsal and ventral meatotomy with a v-shaped relieving incision, 22 eversion meatoplasty, 23 resection and primary end-to-end anastomosis, 24 meatoplasty with double buccal mucosa grafts, 25 or a dorsal preputial island flap 26 and meatoplasty with various other local skin flaps or free skin grafting. 11 Here, a simple wedge meatoplasty similar to the eversion meatoplasty described by el-Kasaby et al 23 and the Mathieu and a V incision sutured (MAVIS) modification of the Mathieu technique for hypospadias repair 27 was used: more complicated techniques involving flaps or grafts were considered inappropriate because of the small diameter of the cat's urethra. Multifilament absorbable suture material was chosen here for mucosal apposition on the basis of the described technique of eversion meatoplasty, 23 availability of the required size, because its softer nature might cause less postoperative irritation than a monofilament material and because it would not require removal and the consequent possibility of trauma to the delicate mucosal apposition.…”

“…11 Here, a simple wedge meatoplasty similar to the eversion meatoplasty described by el-Kasaby et al 23 and the Mathieu and a V incision sutured (MAVIS) modification of the Mathieu technique for hypospadias repair 27 was used: more complicated techniques involving flaps or grafts were considered inappropriate because of the small diameter of the cat's urethra. Multifilament absorbable suture material was chosen here for mucosal apposition on the basis of the described technique of eversion meatoplasty, 23 availability of the required size, because its softer nature might cause less postoperative irritation than a monofilament material and because it would not require removal and the consequent possibility of trauma to the delicate mucosal apposition. Use of a multifilament absorbable material did not appear to adversely affect healing.…”

“…Postoperative complications after meatoplasty in humans include abnormal urine stream, [23][24][25][26] glanular torsion, 24 abnormal appearance of the meatus, 27 wound dehiscence, 11,28 fistula formation 27,28 and stricture formation 24 . Complications were not seen in this case.…”