Hydrocortisone Has No Role in Treating Swollen Meatus from Urethral Stricture
Topical hydrocortisone is not indicated for treating meatal swelling caused by urethral stricture; instead, proceed directly to mechanical intervention with either urethral dilation or meatotomy as first-line treatment. 1
Initial Treatment Algorithm
For uncomplicated meatal stenosis confined to the meatus or fossa navicularis, the appropriate first-line interventions are:
- Simple dilation or meatotomy (with or without guidewire placement) should be performed rather than any topical steroid therapy 2, 1
- These minimally invasive approaches have comparable success rates and directly address the mechanical obstruction 1
- Urethral catheters can be safely removed within 72 hours following the procedure 1
Critical Diagnostic Consideration: Rule Out Lichen Sclerosus
Before attributing meatal swelling solely to stricture disease, you must exclude lichen sclerosus (LS) as the underlying etiology:
- LS should be strongly suspected in spontaneous cases without clear iatrogenic cause, particularly in adult males 1
- Biopsy should be performed if LS is suspected or if the stenosis fails initial treatment, as LS-related disease has fundamentally different treatment implications 1
- Any tissue removed during meatotomy must be sent for pathological review to confirm or exclude LS 1
Management of Treatment Failure
If the meatal stenosis recurs after initial dilation or meatotomy:
- Urethroplasty should be offered rather than repeated endoscopic procedures 2, 1
- Definitive reconstruction should not be delayed if the patient has already failed one endoscopic attempt, as multiple failures worsen subsequent surgical outcomes 1
- Repeated endoscopic treatments or intermittent self-dilation may compromise the success of subsequent reconstructive procedures 2, 1
Why Hydrocortisone Is Not Appropriate
The meatal swelling in urethral stricture represents spongiofibrosis and scar tissue causing mechanical narrowing, not simple inflammation amenable to topical corticosteroids 2. The pathophysiology requires physical intervention to restore urethral caliber. Even in LS-associated disease (where inflammation plays a role), the established stricture itself requires mechanical treatment, though topical steroids may have a role in managing active LS lesions on the glans or meatal skin—but this is separate from treating the stricture itself.
Common Pitfalls to Avoid
- Never use hair-bearing skin if substitution urethroplasty becomes necessary, as this causes urethral calculi and recurrent infections 1
- Do not perform repeated endoscopic treatments beyond one failure, as this creates longer strictures and increases complexity of definitive repair 1
- Always obtain tissue diagnosis when performing meatotomy to avoid missing LS, which changes long-term management 1