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Benign Urethral Lesions in Children – Boys

Boys tend to get affected with certain disorders of the urine system from a young age. These are some of the benign lesions that are seen developing in male children during their formative years. Normally, young male children are able to urinate comfortably, with no pain caused by blockage or other problems.

What are the types of benign lesions commonly seen in boys?

These are some of the benign lesions that are seen to affect boys normally:

Urethral polyps

Urethral polyp forms at the time of birth of the male child usually. It is seen as a tissue covered small abnormal fibrous mass which consists of smooth muscles, small cysts or even nerve tissue in some cases.

In case your child is develops urethral polyps, hematuria (blood in urine) is normally seen along with urinating problems and symptoms similar to UTI (urinary tract infection). This can result in weak and infrequent flow of urine, stress while urinating along with painful and hesitant dribbling stream of urine. Cystoscopy is mostly used to diagnose this condition. This requires inserting a small fiber-optic viewing tube that allows the urologist to check the type of abnormal growth (or polyp). A VCUG (voiding cystourethrogram) may also be used for diagnosis which involves injecting a contrast dye before using x-ray imaging technology to view the inner functioning of the urinary system.

Meatal stenosis

This condition causes the urethral opening at the tip of the penis to be abnormally small. This usually develops due to abnormal tissue growth and scarring at the tip of the penis. Circumcised male children are more prone to this condition than un-circumcised male children. Post-circumcision it is important to maintain cleanliness and excessive hygiene care to prevent this condition.

Other conditions that may cause meatal stenosis include prolonged urethral catheterization, hypospadias, previous surgery for correcting hypospadias, trauma as well as BXO (balanitis xerotica obliterans).

Symptoms that normally indicate meatal stenosis include:

• Infrequent burning sensation while urinating

• Abnormally narrow stream of urine

• Prolonged urination

• Misdirected urine stream

• Blood spots in underwear

• Unidentifiable urethral opening

Congenital urethral fistula

This is a comparatively rare condition and mostly develops when in the fetal stage during pregnancy which results in an additional opening between the penile skin and the urethral opening (fistula). This results in dual streams of urine while urinating. A physical examination is mostly performed to diagnose this condition.

Diverticulum of the anterior urethra

Diverticula (abnormal pouch-formation) in the lower urinary tract may be seen on any of the two sides of the bladder and the urethra. These abnormal masses cause an increase in the passage of the urethra. This is of two types:

• Saccular – This is comparatively less severe and causes the diverticula to form in the floor of the urethra, resulting in weak urine stream as well as inflammation while urinating.

• Megalourethra – This is more severe and affects the urethra all over. This is further classified as – scaphoid megalourethra where the corpus spongiosum is missing – fusiform, where the corpus spongiosum and the corpora cavernosa are missing. This causes the penis to take a spindle-shape when urinating.

The commonly seen symptoms of urethral diverticulum include expanded urethra which makes the penis bulge in the middle while urinating and also results in a weak flow of urine with irregular stream.

Cowper’s duct cyst

Cowper’s gland (bulbourethral gland) is a pea-size gland located right underneath the prostate gland. It works to produce a clear fluid before ejaculation and helps to clean the urethra and neutralize any acids within it to avoid infection from germs. This fluid is also helpful as it acts as a lubricant while having intercourse. Cowper’s duct cysts result in abnormal narrowing of the urethra by expanding themselves. This results in discomfort while urinating, blood spots and weak urine stream which causes the urine to dribble out. VCUG is normally advised to diagnose this condition.

Urethral duplication

Urethral duplication is a fairly rare condition. It may result in complete replica of the organ with one or more openings besides the normal one. Although mostly, this condition is detected by chance the symptoms are usually noticeable. These include dual streams when urinating, infection in the urethra as well as obstruction due to abnormal growth.

How are benign lesions in boys treated?

There are several methods of treatment for different types of benign lesions in boys.
For:

Urethral polyps

Surgical removal is advised for this condition. A minimally invasive surgical procedure using a cystoscope is performed to effectively remove the abnormal mass and clear the passage for normal flow of urine. An electrical instrument is used to cauterize the base of the polyp to prevent further growth.

Meatal stenosis

Meatotomy is the best-suited treatment method for this condition. This requires clamping the urethral before removing the front few millimeters of the urethra until the passage opening is at a wider point. A topical anesthetic is usually applied prior to this procedure on the tip of the penis to prevent pain or discomfort to the child. Parents are then advised to widen the opening manually at least twice a day for 2 to 4 weeks post-treatment. Special ointment is applied on the operated region to prevent this from becoming narrowed again.

An alternative treatment is called ‘urethromeatoplasty’, which is an outpatient procedure. In this, general anesthesia is administered to the child before starting the procedure. The procedure involves widening the narrowed opening using conventional surgical method.

Congenital urethral fistula

Surgical correction is advised in such cases. The surgeon aims to straighten the penile shaft, create a normal channel, position the urethral opening correctly and circumcise or reconstruct the foreskin. This procedure is similar to that required for treating hypospadias.

Diverticulum of the anterior urethra

Initially a comprehensive urological evaluation is advised to prevent severe complications in the future. Once satisfied, the surgeon will perform a surgical correction procedure similar to that required for hypospadias.

Cowper’s duct cyst

Minimally invasive endoscopic surgical technique is useful in removing the thin wall which separates the bulbous urethra and the duct from the opening. In case this minimally invasive technique is not sufficient in some cases, then the surgeon will perform this procedure using conventional open-type surgical technique.

Urethral duplication

In case the extra urethral opening does not cause noticeable discomfort no treatment may be required. In case the additional urethra is close to the original then a small surgical repair can be useful to join the urethral opening into one. In case significant curvature of the penis is also present, then the surgeon may also choose to straighten the penile shaft and remove the additional urethra altogether.

What is the prognosis after treatment of benign lesions in boys?

For:

Urethral polyps

The symptoms noticeable before the surgery are absent and the chances of the polyp recurring are none.

Meatal stenosis

The first three days following the surgery the child may experience pain or discomfort while urinating. Warm bath helps the child to urine with less pain. For older boys, analgesic tablets are prescribed for this period. Minor spots of blood may be noticed for the first few days, which rarely become a cause for concern.
However, it is important to manually widen the opening for the first 7 to 10 days following the surgery and apply ointments at the edges to prevent narrowing again.

Congenital urethral fistula

The doctor will advise on the scheduled regular check-ups that may be required for your kid.

Diverticulum of the anterior urethra

Functionality of the penis with a sac-like mass is restricted to urination whereas milder variants of this condition do not affect the full functioning of the penis.

Cowper’s duct cyst

Symptoms are effectively treated and do not recur in the future.

Urethral duplication

Successful surgery helps to normalize the flow of urine and the condition does not recur.

Frequently asked questions:

Are urethral polyps life-threatening (malignant)?

No. These are completely benign (harmless) growths. However all polyps need to be sent for detailed analysis at the lab after removal.

When should treatment be started for meatal stenosis?

Although meatal stenosis is not an urgent condition, relief is found after medical treatment only.

Do all cases of urethral duplication require surgical correction?

Surgical correction for urethral duplication is advised only in certain cases when there is significant curvature of the penis along with it which results in dual streams of urine flowing out of the penis. The surgical correction is fairly simple and aims to integrate the urethras by removing the common septum separating them.