Prevalence and causes of meatal stenosis in circumcised boys.

INTRODUCTION: The prevalence of meatal stenosis after circumcision remains unclear, and its causes are unknown. OBJECTIVE: To know the prevalence and the causes of meatal stenosis after circumcision in boys. STUDY DESIGN: Between October 2018 and April 2019, we carried out a prospective cross-sectional study on 1031 circumcised boys, aged 5-8 years (mean age 6.1 years ± 0.3 years), enrolled in the first level of primary school. All enrolled children underwent genitourinary examination. Moreover, an anonymous questionnaire was filled-in by one of the parents. RESULTS: The screening revealed the presence of meatal stenosis in 185 children, representing a prevalence of 17.9% of cases (95% CI = 15.6-20.3). Analysis of the results using both the univariate and multivariate mode brought out some common risk factors such as a foreskin that completely adheres to the glans with forceful retraction of the prepuce and the use of a healing product: Beta-sitosterol and Hydrocotyl (Centella Asiatica), rarely Trolamine. In addition, this study showed that boys circumcised during their first week of life are twice as likely to develop meatal stenosis than those circumcised between 7 and 12 months (OR = 2.08; 95% CI = 1.10-3.92, p = 0.021). DISCUSSION: We believe that when the foreskin is fully attached to the glans, forced retraction of the prepuce most often causes a loss of the mucous membrane that covers the glans, making the glans less resistant to chemical attack, and therefore may play an important role in the development of meatal stenosis. However, This study is limited by the absence of a cohort of uncircumcised boys for comparison to see if the small diameter of the meatus is also present in this group. CONCLUSIONS: This study showed that stenosis of the urethral meatus is a frequent complication of circumcision. Circumcision in the first week of life, complete adhesion of the foreskin to the glans, and the use of a healing product were associated with the risk of stenosis development.

Koyanagi- Snow-Hayashi Urethroplasty in Severe Hypospadias Repair: Between Hope and Reality.

OBJECTIVE: To present the results of Koyanagi-Snow-Hayashi urethroplasty in severe hypospadias repair. METHODS: From June 2015 to December 2019, 43 patients with severe hypospadias associated with curvature underwent Koyanagi- Snow-Hayashi urethroplasty. All patients were treated for the first time and by a single surgeon. Thirty-five patients included in this study presented a form of disorders of sex development. The age of the patients at surgery varied from 12 to 120 months (mean age 21 months ± 6 months). The median follow-up was 28 months (range, 5-65 months). RESULTS: Functional and esthetic results were satisfactory with a straight and excellent appearance of the penis, without any complications in only ten patients (23%). While 30 of 43 patients (70 %) required additional procedures. Postoperative complications encountered in our patients were dominated by fistulas which were found in 17 of 43 patients (39.5%). Among them, 3 fistulas appeared in the penile shaft between 11 and 28 days and disappeared spontaneously. While proximal fistulas have been required surgical repair. Diverticulum seemed to be a significant complication of this technique, it was found in 4 of 43 (9%). This study also revealed the presence of a peculiar complication for this procedure, urethral meatus in the shape of fish lips. CONCLUSION: The use of Koyanagi-Snow-Hayashi urethroplasty in severe hypospadias repair gives a complete penile straightening in all cases. However, Despite the modifications added by Snow and Hayashi to Koyanagi urethroplasty to improve the vascular supply of the flap, the rate of complications encountered with this technique remains high.