Skip to Main Content

++

Key Points

++

  1. Meatal stenosis is a condition that alters the direction of the urinary stream, but is not worrisome for obstruction of the urinary tract.

  2. Posterior urethral valves present as a spectrum, from in utero obstruction which can be lethal due to pulmonary hypoplasia to a boy with persistent bedwetting and daytime incontinence. Long-term follow-up is critical to minimize the complications due to “valve-bladder syndrome.”

  3. Dilated ureters that are discovered prenatally can be due to ectopic ureters, primary obstructed megaureters, or ureteroceles.

  4. The management of megaureters has evolved, with many megaureters showing improvement and complete resolution with expectant management. Long-term follow-up is beneficial through adolescence to look for indolent obstructive changes over time.

  5. Antenatal hydronephrosis can represent a ureteropelvic junction (UPJ) obstruction, but the onus is on the clinician to demonstrate the presence of obstruction since the majority of patients detected are asymptomatic.

++

Urinary tract obstruction in children presents in a variety of fashions, from the child who presents with episodic renal colic secondary to an intermittent ureteropelvic junction (UPJ) obstruction to the prenatal findings of a male fetus with significant bilateral hydroureteronephrosis, a distended bladder, and oligohydramnios that can be the hallmark of posterior urethral valves. This chapter will provide a broad overview of various types of obstruction and their pathophysiology, presentation, and diagnosis along with operative techniques to correct these obstructions.

++

Meatal Stenosis

++

Pathophysiology

++

Meatal stenosis in boys is an acquired narrowing of the urethral meatus (Table 65-1). It is the result of prior episodes of meatitis in infants which occurs due to chronic irritation and ammoniacal inflammation of the meatus due to contact with urine, stool, or the diaper in infants who have been circumcised. This chronic meatal irritation leads to progressive, indolent scarring of the meatus with subsequent stenosis.

++
Table Graphic Jump Location
Table 65-1Normal Size of the Urethral Meatus in Boys

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.