2 year old son has problem...

[2boysmomy]

  My 27 month old (day-time potty trained) has been having recurrent trouble with his penis.  The first time I noticed a problem was a couple of months ago when he urinated, but the stream of urine was significantly thinner than normal.  After 2 days of this thin urine stream he was also complaining that his penis hurt.  We took him to a doctor, but by the time we got an appointment it seemed to be better.  A couple of weeks later the same thing happened.  However, this time the meatus seemed to have 'fused' together.  After trying to urinate a few times, I had to physically 'pinch' the tip of his penis to allow him to urinate.  We bathed him, hoping to clean whatever may have been obstructing him, and then noticed a small white blister at the tip.  We took him to the ER (it was Saturday and we had no idea what it was... caled a nurse help line and said to go in and get it checked).  The doctor who saw him cleaned the tip of his penis with a cotton ball saturated with peroxide.  We then saw a pediatrician (for follow-up) and she gave us "Bactroban" to kill any bacteria that may be causing this.  This past Sunday morning he was unable to urinate.  He tried 3 times and then I looked and saw something black in the meatus.  I rushed him to the ER because he couldn't urinate, and I wanted to get this taken care of.  We got to the ER and he was able to go, although it was a thin stream again.  The doctor that saw him this time is giving us a referral to a urologist.  He also told me that he thinks that it looks as if the meatus is almost 'fusing'.  Since then I have read a little bit about male urethral meatal stenonis, and I believe that is what is happenning here.  Please give me any information on this as well as what is done to correct it.  Does being circumcised/uncircumcised increase any risks?  Any information would be beneficial.  Thank you for your time!
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Dear 2boysmommy,
The problem you describe  is called meatal stenosis. The normal size of the urethral meatus varies with age. The diagnosis is made by observation of  decreased caliber of the urine stream. It is felt that the cause of the narrowing at the tip of the urethra is due to irritation of the meatus by ammonia in the urine. There is a strong association between meatal stenosis and circumcision presumably because circumcision results in exposure of the meatus to the diaper increasing the risk of inflammation.
The treatment of meatal stenosis is by surgery called meatotomy. This is a very simple procedure done under anesthesia ( for the child’s benefit). An incision is performed to open the stenotic meatus. Two to three  absorbable sutures may be placed. After the procedure bacitracin is applied to the area to keep the meatus from closing.
Your child should be seen by a urologist to be evaluated for meatotomy. There are several physicians at Henry Ford Hospital that perform  urologic surgery for children these include  Dr. David Burks, Dr.James Peabody and Dr. Stephen Liroff. This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
HFHS MD-KR
*keyword : meatal stenosis