The nozzle problem: Meatal Stenosis of the Urethra

Many patients suffer with lower urinary tract symptoms often caused by benign enlargement of the prostate. Their complaints may include varying combinations of a slow weak stream, pushing to void, frequency day and night, urgency, sleep interruption, and incomplete emptying.

Sometimes, however, a patient will also describe difficulty in directing the flow or aim of the urinary stream. His wife complains that he is always wetting the toilet bowl and floor. This is when the doctor will recognize a symptom a little different from the others. This nozzle problem may be due to a condition known as “Meatal Stenosis.” It is a narrowing of the very end of the urethra at the tip of the penis. This narrowing can become severe so that the opening, normally a slit of a quarter inch or more may become only a pinpoint in size.

A man may have been born with this condition or it may be a complication of circumcision or, as recently reported to me, trauma inflicted by catching the tip of the penis in a zipper several years earlier. When this occurs in a middle-aged man who also has an enlarged prostate, it’s important to attribute the symptoms to the correct diagnosis. Correcting one condition will not necessarily correct the other so it’s wisest to proceed in a stepwise fashion, correcting the simplest condition first and evaluating the effect of treatment before proceeding to the more complex.

The first thing to do is to correct the urethral meatal stenosis and this can easily be done in the office. If the lower urinary tract symptoms persist after the opening at the tip has been accomplished, attention is turned to the prostate.

Medical treatment is usually tried first using a combination of medications; one to shrink the glandular portion of the prostate and another to relax the muscular portion of the prostate. If this treatment is given a fair trial and the patient for whatever reason, doesn’t want to continue with a lifetime of drug therapy, consideration should then be given to the use of microwave thermotherapy, which can comfortably be given in the office, avoiding hospitalization and anesthesia. This is a well-tolerated, long lasting and safe non-surgical procedure. There is no cutting or removal of tissue and no interference with the patient’s sex life as occurs with the various prostate surgical procedures, such as open prostatectomy, TURP, and LASER each of which requires hospitalization or the equivalent and anesthesia and the wearing of an uncomfortable catheter after the operation. Each of these surgical procedures is followed by permanent “Retrograde Ejaculation.”. This means that orgasm is no longer accompanied by the discharge of seminal fluid. One patient with a colorful command of the English language described it as “Shooting Blanks.” This can be avoided by use of the TherMatrx microwave thermotherapy treatment.

Have a question? Call Dr. Okun at 718-241-6767

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