Strictures of the meatus have quite a different cause and prognosis from the gonococcal ones in Section 23.8. You may see them in children, or adults, and they may be congenital, or acquired. The most important acquired cause is infection associated with instrumentation and catheterization. In adults a meatal stricture may be due to the skin disease called balanitis xerotica obliterans (''BXO', also called lichen sclerosis atropica). This also involves the foreskin, so there is usually an associated phimosis also.
MEATAL STRICTURES Dilatation should nearly always preceed meatotomy.
If a meatal stricture develops in a child, give his mother a plastic rod to keep it dilated. The rounded plastic containers used for disposable needles are very suitable. Ask her to lubricate it with vegetable oil. If necessary do a meatotomy as described below.
If a meatal stricture develops in an adult, first try dilatation as above. Although general anaesthesia is preferable, you can, if necessary, infiltrate his fraenum and his glans immediately under it with anaesthetic solution. Alternatively, do a ring block of the base of his penis as in Section 23.26. Put one blade of a pair of fine-pointed scissors into his meatus, and cut its ventral aspect in the midline. To stop his stenosis recurring, cut 1.5 cm beyond his meatus, and suture his mucosa to his skin. Use the first two stitches on either side as retractors to open the wound, and expose the mucosa of his urethra. Insert a suture at the apex of this incision to control bleeding from his frenal artery. His meatus may restenose, so give him a dilator.
If there are signs of BXO (see above), hydrocortisone cream will help to prevent recurrence. Let him apply it into his meatus from the nozzle of a small tube, which will then act as a dilator.
Fig. 23-38 MEATOTOMY. A, although general anaesthesia is preferable, you can infiltrate a patient's fraenum and glans with anaeshetic solution. B, introduce one blade of a pair of fine scissors into his urethra. C, cut 1.5 cm beyond the stenosis. D, suture his mucosa to his skin. E, the plastic cover of a disposable needle makes a good dilator. Kindly contributed by Neville Harrison.