Purpose of the operation
In meatal stenosis, the urinary opening at the tip of the penis becomes narrow. Peeing hurts, the stream is thin and points upward or sideways, and voiding takes a long time. Meatoplasty widens the opening to a normal size and relieves these symptoms.
The narrowing most often develops months or years after circumcision in infancy.
Who needs it?
Surgery is done only when the narrowing causes symptoms:
- a thin or upward-pointing stream that the boy cannot aim into the toilet,
- pain or stinging when peeing,
- long voiding or straining,
- a spot of blood on the underwear.
If the opening looks narrow but the stream is normal and there are no symptoms, surgery is not needed.
How is it done?
- Meatotomy: the lower edge of the opening is briefly pressed with a fine clamp and then cut. The opening becomes wider.
- Meatoplasty: after the cut, the lining of the urethra is stitched to the skin of the glans with fine dissolving stitches. This stops the edges from sticking together again.
The method depends on the shape of the narrowing. The procedure takes 10–15 minutes. In children it is usually done under a short general anesthetic with local numbing of the penis (anesthesia in children). In older, calm children local anesthesia alone is sometimes enough.
At home after surgery
- Your child goes home the same day. A dressing is usually not needed.
- The first few times he pees there may be mild stinging and a drop or two of blood. Sitting in warm water and drinking plenty of fluids make peeing easier.
- Ointment: as the doctor shows you, apply ointment to the edges of the opening several times a day for several weeks. The aim is to keep the edges from sticking together again.
- Showering is fine from the next day.
- Paracetamol or ibuprofen in an age-appropriate dose is enough for pain.
- The stitches dissolve on their own and do not need removing.
Results
In most boys the stream returns to normal and the pain and difficulty with peeing go away. Narrowing can recur in rare cases. Aftercare should follow the surgeon’s instructions.
Follow-up
A check-up is done a few weeks after surgery to look at the size of the opening and the stream. If needed, the stream is measured with uroflowmetry.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Unable to pee for 8–12 hours after surgery
- Bleeding that does not stop with pressure
- High fever or spreading redness
Note for pediatricians and family doctors
The indication is symptomatic meatal stenosis: a thin, dorsally deflected or spraying stream, dysuria, prolonged voiding or a spot of blood on the underwear. A meatus that merely looks narrow but causes no symptoms and gives a normal stream does not need surgery. Meatotomy divides the ventral edge of the meatus; in meatoplasty the urethral mucosa is also sutured to the glans skin with fine absorbable sutures so the edges do not fuse again. In older, cooperative children some centers perform the procedure under local anesthesia. Applying ointment to the meatus for several weeks after surgery is usually recommended.
What happens at the visit?
- We assess the stream from the parents' observations and, if needed, with uroflowmetry.
- We examine the urinary opening and decide whether the narrowing is causing symptoms.
- If surgery is needed, we explain the method, anesthesia and home care.
Frequently asked questions
The opening looks narrow but my son has no symptoms. Does he need surgery?
Usually not. If the stream is normal and there is no pain or difficulty, observation is enough. Surgery is for narrowing that causes symptoms.
Can the narrowing come back?
It can recur in rare cases. Follow the surgeon's aftercare instructions and come to the follow-up visit.
Will peeing hurt after the operation?
The first few times there may be mild stinging and a drop or two of blood. This settles within 1–2 days. A warm bath and plenty of fluids help.
Related topics
- Meatal stenosisNarrowing of the urinary opening after circumcisionCondition
- Circumcision complicationsCircumcision errors, revision circumcisionCondition
- CircumcisionCircumcision surgery, cosmetic circumcisionOperation
- UroflowmetryUrine flow testTest
- Anesthesia in childrenAnesthesia, fasting rules, preparing for surgeryOperation
Sources
- EAU Guidelines on Paediatric Urology, 2026.
- Ben-Meir D et al. Meatotomy using local anesthesia and sedation or general anesthesia with or without penile block in children: a prospective randomized study. J Urol, 2011.
- Varda BK et al. Minor procedure, major impact: Patient-reported outcomes following urethral meatotomy. J Pediatr Urol, 2018.
References to the EAU Paediatric Urology guidelines were checked against the 2026 edition (October 2026).
This information is for educational purposes and does not replace medical advice. Decisions about your child’s treatment are made with the doctor after an examination.
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