Does Circumcision Cause Meatal Strictures
PURPOSE The causal relationship between circumcision and meatal strictures is controversial. We reviewed our data and assessed the roles of possible etiologic factors. MATERIAL AND METHODS Seventy six patients who underwent circumcision both for traditional and medical reasons at the department of Urology between 2004 and 2006 were included in the study. Meatal calibrations were achieved using lubricated polyethyhlene tubes by the same surgeon, such that the largest caliber tube that did not stretch the external meatus and fossa navicularis represented the meatal size. Postoperative meatal caliber was assessed at 1 to 3 months (mean:1.4) after the circumcision. Circumcision techniques were categorized with respect to the competence of phrenular artery. Circumferential incision was made at a more proximal level on the ventral aspect of the penis and no cautery to, or ligation of phrenular artery was performed in those who underwent phrenulum-sparing circumcisions. The influence of phrenulum sparing, diapers and preoperative gonadotropin treatment on the postoperative percent change in meatal calibration was assessed statistically. RESULTS Mean patient age was 35.4 months (range 1 to 102). Pre and postoperative mean meatal calibers were 10.53F and 10.11F respectively. Overall decrease in meatal caliber (3.98%) was statistically significant (p=0.0001). Preoperative gonadotropins, although statistically insignificant, seemed to have a protective effect. Phrenulum sparing did not prevent meatal downsizing (p=0.005). Having diapers seemed to be a greater risk factor for meatal strictures (p=0.001). CONCLUSIONS Decrease in meatal caliber as early as 1 to 3 months after circumcision is statistically significant, though clinical importance of this decrease is yet to be determined.