Meatotomy

Meatotomy procedure

A meatotomy is a small operational procedure that is used to enlarge or dilate the urethral meatus - the hole at the end of the penis. It is normally performed in children and adults with difficulty in urinating because of the narrowing of the meatus (meatal stenosis).

What Is Meatotomy?

• Meatotomy is an easy outpatient surgery that requires the surgeon to make a small incision at the urethral orifice to enlarge it and enhance the passage of urine.
• It is most commonly performed in local anaesthesia in adults and general anaesthesia in children.

Indications for Meatotomy

The meatotomy can be prescribed by your doctor because of:

Meatal Stenosis

Most frequent cause, commonly as a result of:

• Congenital narrowing
• Disfigurement following circumcision.
• Persistent irritation or inflammation.

Poor Urinary Stream

• Slim, upward deflected or spraying urine stream.
• Prolonged urination

Pain during or after Urination

By passing urine:

• Reoccurring Urinary Tract Infections.
• Problem with Withdrawing Urine.

Meatotomy Procedure: 

Anaesthesia

• Local anaesthesia (adult)
• General anaesthesia (children)

Preparation

• Penis is washed and covered.

Incision

• To enlarge the urethral opening a small incision is made at the underside.

Suturing (Optional)

• Other surgeons place the meatus in dissolvable stitches.
• There are numerous cases that do not presuppose sutures.

Application of Ointment

• Topical petroleum jelly/antibiotic is used.

Discharge

• Patients go home the same day.
• Duration: 10–20 minutes
• Hospitalization: Day-care (no hospitalization required)

Recovery After Meatotomy

Pain:

• Mild discomfort for 2–3 days.

Healing Time:

• 1–2 weeks for complete healing.

Care Instructions:

• Apply ointment 2–3 times daily.
• Keep the area clean and dry.
• Sitz baths are warm and are used to alleviate pain.
• Avoid straddle exercises (cycling, rough play) in 1-2 week.
• Take lots of water so as to urinate easily.

Return to normal activities:

• School/work: 1–2 days
• Sports: 1–2 weeks
• Adults (sexual activity): in 3-4 weeks.

Success Rate

• The success rate of meatotomy is very high (90-98%).
• Urine flow is improved immediately in most patients.

Factors Affecting Meatotomy surgery cost India

The following are the determinants of the high and low cost of a meatotomy:

Experience of the Surgeon and his reputation

• A very qualified urologist who has an excellent record might be expensive. 
• In case the surgeon is a paediatric urology specialist or complex cases, the prices might be higher.

Type and Location of Hospital / Facility

• The overheads (metropolitan cities, corporate chain hospital, international accreditation) of premium hospitals are higher, therefore, cost are higher. 
• Location will have an impact: e.g., hospitals located in big metros (Delhi, Mumbai, Bangalore) will be generally more expensive than small cities or regional hospitals.

Complexity of the Case

• In the case of a simple and straightforward meatal stenosis, it will be less expensive.
• In case there are complicating factors (e.g. related urethral stricture, repeated operation, paediatric patient, anatomical variation) it will be more expensive.
• In case extra measures are required (e.g., reconstruction, suturing, catheterisation) the price increases.

Type of Procedure

• Simple meatotomy (simply enlarging access) is less costly.
• More advanced ones such as a meatoplasty (longer modification + sutures) are more expensive. 
• Advanced technique/technology (despite the fact that meatotomy is a relatively minor procedure) can be expensive.

Hospital Stay / Room Category

• Although, meatotomy is usually an outpatient or a short-stay surgical process, in cases where a patient will need a longer hospitalization (e.g., owing to his/her condition), room charges will accumulate. 
• Selection of deluxe/ private room or shared room will affect costs.

Anaesthesia / Operating Theatre Bills

• Even small surgeries need anaesthesia, operating time, sterilisation etc. These costs vary.
• Application of local or topical as opposed to general anaesthesia can impact cost. (Some studies have observed that topical anaesthesia is applicable in meatotomy, though in some cases) 

Pre-operational Tests and after care

• The cost is increased with pre-surgery tests (blood tests, urine tests, imaging).
• Additional ones include post-operative medications, follow-up visits, dressing/ointments.
• These all-in-one and those that are billed separately come in some packages.

International Patient Services/ Medical Tourism

• In case you are an international visitor (medical tourism) then there might be extra charges of services (translation, pick-up, accommodation) which increase the cost.
• There are also exchange rates, travelling, accommodation etc that become part of total cost (but technically not cost of surgery).

Complications & Revision Surgery

• In case of complications (bleeding, infection, necessity to revise it), extra costs are received.
• The revision meatotomy or more complicated variant is more expensive than the standard procedure.

Meatotomy for meatal stenosis

A meatotomy is a small surgical process that is done to repair meatal stenosis, which is a condition of the urinary opening (meatus) being narrowed abnormally. This constriction influences the urine flow and it may cause multiple urinary symptoms. The normal and most effective intervention of meatal stenosis in adults and children is meatotomy.

What Is Meatal Stenosis?

• Meatal stenosis is constriction of the urethral aperture at the distal penis.

It is commonly seen in:

• Circumcised boys
• Adults having irritation or inflammation of the urethra.
• Recurrent infections with patients.
• Patients with lichen sclerosus.

Why Meatotomy Is Done for Meatal Stenosis?

The enlarged urethral aperture is achieved through a meatotomy to resume normal urinary discharge.

It is recommended when:

• Quality of life is influenced by symptoms.
• Treatment Conservative (topical steroids, dilation) fails.
• The stenosis is moderate and severe.
• Frequent UTIs or straining take place.
• A child experiences abnormal urine stream constantly.

Advantages of Meatotomy for Meatal Stenosis

• Removes congestion in a short period.
• Enhances the flow and direction of urine.
• Less spraying and dribbling.
• Reduces UTI risk
• Removes struggling or suffering.
• High long-term success (90–98%)
• Fast recovery and short recuperation.

Best hospital for meatotomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Meatotomy recovery time

Meatotomy is a low-risk outpatient procedure that widens the urethral orifice, typically associated with meatal stenosis. The recovery is normally fast and simple.

Immediate Post-operative Period

• Time interval: 1-2 hours in-hospital/day-care.
• Discharge: Most adults and older children are discharged the same day.
• Pain/Discomfort: Mild burning or soreness on the end of penis.
• Treatment: Narcotics and antibiotic ointment can be prescribed.

First Week

• Urination: Stream improves instantly, but slight burning could occur.
• Ointment: lubricate with antibiotic or petroleum jelly 2-3 times per day.
• Bathing: Sitz warm baths are used to alleviate pain.
• Activities: Cycling, running or activities that can cause pressure on the penis should be avoided.

1–2 Weeks

• Healing: The majority of the incision heals in 1-2 weeks.
• Follow-Up: Surgeons can visit the location to make sure the healing is okay.
• Normal Activities: The majority of patients are able to resume daily activities in 1-2 days, however, avoid vigorous exercise.

3–4 Weeks

• Sexual Activities: It is safe to resume after 3-4 weeks in adults.
• Full Recovery: Healing and restoration of urethral opening in full and normal state.

Meatotomy complications

The procedure of meatotomy is typically a minor and safe surgery, however, just as any surgery; it has some risks that can be associated with it. The majority of complications are minor and uncommon.

Bleeding

• The first 24 hours are characterized by mild bleeding of the incision.
• Typically spontaneously heals or pressure dressed.
• Over-bleeding is not common but can be taken to a doctor.

Infection

• The symptoms are redness, swelling, pus or more pain at the site.
• Prevention: Good hygiene and antibiotic ointment of prescription.
• Therapy: Oral or topical antibiotics in case of infection.

Pain or Discomfort

• It is normal for a few days, slight soreness, burning or stinging during urination.
• Typically treated through pain killers and warm sitz baths.

Urinary Spraying

• There are patients who get a temporary spraying or deflection of urine stream.
• Typically gets better when the meatus heals and the tissue settles.

Reoccurrence of Meatal Stenosis

• Rare, and could occur in case of scar tissue development.
• May need a repeat operation or minor revision of the meatotomy.

Over-Widening of the Meatus

• Extremely uncommon complication in which the opening is excessively broad resulting in slight sprays of urine.
• Mild, most of the time; seldom necessitates surgical correction.

Scarring

• There is a possibility of some patients forming a scar tissue at the point of incision.
• Typically has no influence on the urine flow.

Allergic Reaction

• Exceptional responses to anaesthesia, antiseptic ointments or dressings.
• Typically mild; the severe reactions are very rare.

Rare Complications

• Beyond meatal urethral injury.
• Patients who have diabetes or with poor wound healing have delayed healing.
• Children painful erections (infrequent)

Conclusion

Meatotomy is a surgical procedure that is cheap, safe, and can be widely done to correct meatal stenosis or a small urethral opening. It gives a quick relief of such symptoms as weakening or spraying urine stream, straining, pain, and frequent urinary tract infection. The treatment is fast, usually outpatient and comes with little pain and high success rate. Improved urine flow is observed in most patients and lasts through to 1-2 weeks when they are fully recovered. Although complications such as bleeding, infection and recurrence may occur, they are uncommon and can be easily controlled when appropriate post-operative care is provided. It is therefore observed that meatotomy is a very effective remedy towards normal urinary functioning, comfort, and quality of life to both children and adults.

Meatotomy surgery in India with GetWellGo

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• Complete transparency
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• Assistance in selecting India's top hospitals for Meatotomy treatment.
• Expert urosurgeon with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food

FAQ

Is meatotomy painful?

• As a surgical procedure: anaesthesia prevents pain.
• Postoperative: Slight burning or soreness may take several days and are relieved by painkillers.

Will there be an immediate improvement of the urine flow?

• Yes. The majority of the patients report the increase in the urine flow right after the surgery, yet the slight burning can last several days.

Is it possible to perform meatotomy without any stitches?

• Yes. A stitch-free meatotomy is a commonly used procedure by many surgeons and it heals quite well, and eliminates the chances of discomfort at the suture.

Is it safe to do meatotomy among children?

• Yes. Meatotomy is a common practice in pediatric urology, and it is believed not to have serious complications with low safety.

Are any alternatives to meatotomy?

• Topical steroid ointments and gentle dilation can be used in mild cases, but surgery is considered the final answer.