Calibration and dilatation with topical corticosteroid in the treatment of stenosis of neourethral meatus after hypospadias repair

Abstract

To assess the early disclosure and treatment of meatal stenosis after hypospadias repair, using calibration of the neourethral meatus at regular intervals to detect stenosis, and to assess the curative effects of dilatation with topical corticosteroids. Between 2001 and 2003, 83 boys (median age 19 months, range 12-28) had a proximal hypospadias repair using a tubularized skin island-flap urethroplasty. The neourethra was calibrated every 7-15 days with newly designed small and fine metal sounds (5-12 F) for 3 months starting 7-10 days after surgery. The patients with meatal stenosis were treated by dilatation using topical 0.05% betamethasone cream daily (twice per day) for 3 months. The mean (range) follow-up was 29 (12-37) months; 19 patients who developed early stenosis were treated by dilatation with topical steroids. After treatment, 14 neourethras were passable with a minimum sound of 10 F at regular 6-12 months assessments. Stenosis persisted in five patients who did not respond to the treatment; of these, a diverticulum developed in one and a fistula in two. All patients with permanent complications were re-operated. There were no adverse effects in any of the patients treated with topical 0.05% betamethasone cream. Early calibration and dilatation of the neourethra after hypospadias repair is a useful method for the early disclosure and treatment of meatal stenosis. The newly designed sounds made calibration/dilatation less unpleasant and more acceptable for the patient. Topical corticosteroids improved scar elasticity, which facilitated dilatation and prevented the formation of meatal stenosis.