title: Meatal stenosis: a retrospective analysis of over 4000 patients.
abstract: OBJECTIVE
  The literature on treatment of meatal stenosis is limited to single center series. Controversy exists regarding choice of meatotomy versus meatoplasty and need for general anesthesia. Our objective was to analyze treatment efficacy, current practice patterns and utilization of anesthesia. We hypothesized that meatoplasty would be associated with a lower re-operative rate.
  
  
  METHODS
  We used a hospital consortium database to identify children who were diagnosed with meatal stenosis between January 1, 2009 and December 31, 2012. Both univariate and multivariate analyses were completed to evaluate correlations between patient, surgeon and hospital characteristics and type of procedure. The propensity of surgeons to operate with or without general anesthesia was analyzed.
  
  
  RESULTS
  We identified 4373 male patients with a diagnosis of meatal stenosis treated by 123 surgeons. Fifty-percent of boys had procedural intervention during the 4-year period. Median follow-up was 25 and 22 months after meatotomy and meatoplasty, respectively. There was a re-operative rate of 3.5% and 0.2% for office meatotomy versus meatoplasty with general anesthesia. Multivariate analysis demonstrated that being White and living in the Northeast independently increased odds of intervention. Half of the surgeons treated meatal stenosis exclusively under general anesthesia.
  
  
  CONCLUSIONS
  This study is limited by an inability to determine recurrence rates. Only patients having secondary surgery at the same institution within the time period captured by the database (6 months-4 years) could be identified. As such, the true recurrence of meatal stenosis is likely higher. Although the re-operative rate is not equivalent to the recurrence rate, the two are correlated. Likewise, the surgeon's propensity to operate could be biased by their propensity to diagnosis meatal stenosis and this could affect the rates cited. In addition to the cost benefit achieved with avoidance of general anesthesia (estimated to be a 10-fold cost reduction, the 2012 Consensus Statement of the International Anesthesia Research Society has highlighted that there is increasing evidence from research studies suggesting the benefits of general anesthesia should be considered in the context of its possible harmful effects. Although this study and others have highlighted that in-office procedures are a viable alternative to meatoplasty with general anesthesia, there are multiple factors in being able to perform an office meatotomy. Arguably, the two most important are the patient's ability to cooperate and his anatomy.
  
  
  CONCLUSIONS
  The large sample size, over 4000 patients, allowed us to show that the hypothesis, that meatoplasty would be associated with a lower re-operative rate (0.2%), is true. With a low re-operative rate (3.5%), office meatotomy is a reasonable choice of surgical treatment if the child can cooperate and the anatomy is appropriate. On the other hand, if general anesthesia is utilized, formal meatoplasty is associated with a lower re-operative rate.
authors.affiliation: Department of Urology, University of California Davis, Sacramento, CA, USA.
authors.forename: Shelley P
authors.initials: SP
authors.lastname: Godley
authors.affiliation: Department of Urology, University of California Davis, Sacramento, CA, USA.
authors.forename: Renea M
authors.initials: RM
authors.lastname: Sturm
authors.affiliation: Division of Biostatistics, University of California Davis, Davis, CA, USA.
authors.forename: Blythe
authors.initials: B
authors.lastname: Durbin-Johnson
authors.affiliation: Department of Urology, University of California Davis, Sacramento, CA, USA. Electronic address: eric.kurzrock@ucdmc.ucdavis.edu.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Kurzrock
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
keywords: Anesthesia; Circumcision male; Complications; Stenosis; Urethra