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Summary-This
paper is a review of the treatment of 32 cases of meatal stenosis arising as a
complication of recurrent balanoposthitis (26 cases) or balanitis xerotica obliterans (six cases). There
was gross scarring of the glans and the terminal urethra resulting in a contracted glans and a pinhole
meatus. These deformities were treated successfully by segmental excision of all the scar on the glans
and resurfacing the raw area with a local preputial or penile skin flap. In two patients a ventral midline flap
was introduced as an island flap. In no case was a ventral slit made as the only definitive treatment of the
meatal stenosis. Two instruments were made specifically to facilitate this type of operation.
Fig. 1
Figure l-Scarred
glans with a pinhole
stenosis with two fistulae.
Fig. 2
meatus.
117
xerotica
obliterans.
Figure 2-Meatal
118
Fig. 3
Fig. 4
usting the spring-loaded
. .
r..
MEATOPLASTY
FOR GROSS
URETHRAL
119
STENOSIS
Technique of meatoplasty
A suitably sized Bowmans lacrimal probe is gently
negotiated through the narrow meatus. This
usually gives enough dilatation to insert a specially
designed combined retractor-and-spreader
(Figs. 3
and 4) though sometimes an initial nick with a
narrow No. 11 scalpel blade is necessary. The
retractor-and-spreader
is then opened out and a
third to one half of the circumference of the
scarred glans around the meatus ventrally and the
adjacent urethral floor is radically excised extending proximally as far as 1 cm. Local injection of
saline-adrenaline (1 : 200,000) into the scar before
excision reduces bleeding. The resulting raw area is
covered by a split-skin graft or by one of the local
flaps listed in the Table below. The flap is sutured
to the margins of the raw area. The ends of the
deep stitches are left long and tied over rubber
tubing. A catheter of a suitable size is now
introduced and fixed in place by the sutures that
were left deliberately long. Stitches are removed on
the tenth day.
Table
Results of the use of free split-skin
local flaps in a series of 32 patients treated
for meatal stenosis
Procedure
Free graft
Number of
patients
Success
Failure
(a) Preputial
(b) Lateral
17
17
32
30
Flaps:
(cl
Median
(d) Island
Total
Results
Fig. 5
Figure 5-Result
of meatoplasty
3 months after operation:
good stream of urine with no spraying or splattering.
Discussion
Cohney (1963) advocated a ventral slit and covering the area with a lateral penile skin transposition
flap. Blandy and Tressider (1967) later preferred a
Acknowledgement
We wish to thank the South India Surgical Company, Madras,
India, for making the instruments
described in this paper.
120
References
Blandy, J. P. and Tressider, G. C. (1967). Meatoplasty. British
Journal of Urology, 39,633.
Journal
of
The Authors
Satya Parkash, FRCS(Eng), Professor of Surgery and Medical
Superintendent,
Jawaharlal
Institute of Postgraduate
Medical Education and Research, Pondicherry, India.
V. Gajendran, MS, Senior Resident, Department of Surgery,
Jawaharlal Institute of Postgraduate Medical Education and
Research, Pondicherry, India.