Successful Meatoplasty for Meatal Stenosis in a 67 Y.O. Male with Multiple Comorbidities

Chief Complaints

A 67-year-old male patient with a Body Mass Index (BMI) of 20 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of weak urinary stream for the past 1 year. The symptom was suggestive of narrowing at the urinary opening, affecting normal urine flow.

The patient had a past history of partial penectomy done for carcinoma of the penis. He was a known case of coronary artery disease (CAD), diabetes mellitus, hypertension, obstructive sleep apnea, chronic kidney disease, and had a history of smoking. He was on regular medications for his existing medical conditions.

On examination, the patient was conscious, coherent, and oriented, with stable vital signs. General and systemic examination did not reveal any acute abnormalities. Local genital examination revealed narrowing of the external urinary opening, consistent with meatal stenosis.

Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Urology team, including a detailed review of his medical history and focused clinical examination. He presented with a weak urinary stream for the past 1 year, raising clinical suspicion of narrowing at the urinary opening.

The patient had a significant past history of partial penectomy for carcinoma of the penis. He was also a known case of coronary artery disease, diabetes mellitus, hypertension, obstructive sleep apnoea, chronic kidney disease, and had a history of smoking. These comorbid conditions were taken into consideration during preoperative evaluation and treatment planning.

Local examination revealed meatal stenosis, confirming narrowing of the external urinary opening as the cause of the patient’s weak urinary stream. 

Based on the confirmed diagnosis, the patient was advised to undergo Meatal Stenosis Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with Dr K Ravichandra (Consultant Laparoscopic Urologist), a comprehensive urological evaluation was performed for the patient, who presented with a weak urinary stream for the past 1 year. The patient had a significant history of partial penectomy for carcinoma of the penis, along with multiple comorbidities and a smoking history.

On local examination, the patient was found to have meatal stenosis, which means narrowing of the external urinary opening. This finding correlated with his complaint of a weak urinary stream and confirmed the need for urological intervention to improve urinary flow.

Considering the confirmed diagnosis, it was determined that meatoplasty was the most appropriate intervention to widen the narrowed urinary opening, improve urine stream, reduce urinary difficulty, and prevent further complications such as worsening obstruction, urinary discomfort, infection, or retention.

The patient and family were counselled regarding the diagnosis, planned procedure, expected benefits, and informed consent was obtained for the procedure.

Following the decision, the patient was scheduled to undergo Meatoplasty Surgery in Hyderabad at PACE Hospitals under the expert care of the Urology Department.

The procedure involved the following steps:

• Patient Preparation and Anaesthesia: The patient was taken to the operating room after completing the necessary preoperative evaluation and investigations. Standard aseptic preparation and draping were performed. Anaesthesia was administered as per the anaesthesia team’s assessment, and the patient was positioned appropriately for the procedure.

• Local Examination and Surgical Planning: The narrowed external urinary opening was identified and assessed. The surgical site was carefully evaluated, especially considering the patient’s previous history of partial penectomy for carcinoma penis.

• Meatal Widening: A meatoplasty was performed to widen the narrowed urinary opening. The stenosed meatus was surgically released and reshaped to improve the urinary outlet and allow better passage of urine.

• Hemostasis and Wound Care: Bleeding points were controlled, and the surgical area was cleaned. The wound edges were appropriately adjusted to maintain a wider meatal opening and reduce the chance of recurrent narrowing.

• Catheter Placement and Completion: A urinary catheter was maintained postoperatively to support urine drainage and healing of the operated area. 
  

Postoperatively, the patient was monitored for hemodynamic stability, urine output, pain control, catheter care, and immediate surgical recovery. The procedure was uneventful, and the patient remained stable throughout the postoperative period. During the hospital stay, the patient was managed with medications to prevent infection, medications for pain relief, gastric protection, and continuation of regular medications for his existing medical conditions. 

Upon discharge, the patient was prescribed medications to prevent infection, control pain, and protect the gastric lining for a short duration. He was also advised to continue his regular medications for diabetes mellitus, hypertension, coronary artery disease, and other existing medical conditions as instructed by the treating team. Proper catheter care was advised to support healing and prevent urinary complications.

The patient was advised to follow a low-salt and low-meat diet, considering his existing medical conditions. He was instructed to take all prescribed medications regularly, maintain proper catheter care, and follow the urologist’s postoperative instructions for smooth recovery.

The patient was instructed to contact the emergency ward at PACE Hospitals in the event of an emergency or development of symptoms such as fever, blood in urine, burning urination, catheter blockage, severe pain, reduced urine output, or worsening urinary symptoms.

The patient was advised to return for follow-up with the Urologist in Hyderabad at PACE Hospitals after 5 days for catheter removal and further urological assessment.

This case highlights a meatal stenosis with a weak urinary stream for 1 year, with a past history of partial penectomy for carcinoma penis and multiple comorbidities. He underwent successful meatoplasty under the Urology Department. The procedure was uneventful, and he was discharged in stable condition with catheter care advice, dietary instructions, and follow-up for catheter removal.