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Updated: May 24, 2025
Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
Meatal stenosis and lichen sclerosus in children: is it a real risk? A single-centre retrospective observational
R Angotti1, F Nascimben1, M Messina1
1Division of Pediatric Surgery, Department of Medical, Surgical and Neurosurgical Sciences, Policlinico Le Scotte, Siena, Italy.
Insights
Early diagnosis and treatment of Lichen Sclerosus (LS) in children are crucial to prevent complications like urethral meatal stenosis. Histology can predict complications, guiding necessary follow-up and corticosteroid treatment.
Area of Science:
- Pediatric Urology
- Dermatology
- Genitourinary Surgery
Background:
- Lichen Sclerosus (LS) in pediatric patients requires prompt diagnosis and management to prevent severe complications.
- Urethral meatal stenosis is a significant complication that can arise from untreated or inadequately managed LS.
Purpose of the Study:
- To evaluate the incidence of LS-linked complications, specifically urethral meatal stenosis, in pediatric patients who underwent circumcision.
- To assess the correlation between histological findings of LS and the development of postoperative complications.
- To investigate the impact of circumcision on the occurrence of LS-related issues.
Main Methods:
- Retrospective analysis of pediatric patients (age >5 years) with LS histology post-circumcision (Jan 2015-Dec 2021).
- Evaluation of demographic, surgical, and postoperative data, including physical exams, quality of life questionnaires, and uroflowmetry.
- Stratification of patients based on physical and histological findings to assess LS-related complications and need for urethral dilatations.
Main Results:
- Of 95 evaluated patients, 19% showed pathological uroflowmetry, with increased incidence correlating to meatal stenosis grade.
- Higher grades of meatal stenosis (grade 1 and 2) were associated with a greater percentage of abnormal uroflowmetry results (15% and 33%, respectively).
- Four patients (4.7%) with meatal stenosis required urethral dilatations.
Conclusions:
- Histological assessment of Lichen Sclerosus is effective in identifying pediatric patients at risk for complications like meatal stenosis.
- Close follow-up and a minimum of one-month corticosteroid treatment are recommended for pediatric LS patients to optimize surgical outcomes.
Background:
Early diagnosis, early treatment and long-term follow-up in paediatric patients with Lichen Sclerosus (LS) are mandatory to avoid complications such as urethral meatal stenosis.
Methods:
All patients older than five years who underwent circumcision from January 2015 to December 2021 at our centre with positive histology for LS were included. Demographic, preoperative, surgical and postoperative data were analysed. Patients were physically evaluated, and they were asked to fill in two quality of life questionnaires and to perform an uroflowmetry. They were stratified into clusters according to physical and histological examination. Urethral dilatations were investigated to assess the correlation between circumcision and incidence of LS-linked complications.
Results:
Among 99 patients included in the study, 95 were finally evaluated. Median age at diagnosis was seven years (range, five to ten years). Median age at surgery was 10.8 years (6-17). Urethral meatus was grade 0 in 47% of cases, grade 1 in 41% and grade 2 in 12%. A total of 19% of circumcised patients with LS had pathological uroflowmetry: the number of patients with pathological uroflowmetry increased as the grade of meatal stenosis increased (13% grade 0, 15% grade 1 and 33% grade 2). Four (4.7%) patients with diagnosis of meatal stenosis underwent meatal dilatations.
Conclusions:
By assessing histology of LS it is possible to determine who will develop LS-linked complications such as meatal stenosis. Patients with LS must be followed-up closely and should be treated with corticosteroids for at least for one month to improve their postoperative outcomes.
