Urethral Prolapse

Urethral Prolapse: Excerpt from The 5-Minute Pediatric Consult

Stephen A. Zderic, MDMichele Clement, MD (4th Edition)

Urethral Prolapse - BASICS

Urethral Prolapse - description

• Circular eversion of the distal urethral mucosa through the external urethral meatus
• Classification of urethral prolapse:
  • I-Minimal of segmental inflammation
  • II-Circumferential prolapse with edema
  • III-Edematous mass protruding beyond the labia minora
  • IV-Severe hemorrhagic inflammation or necrosis and ulceration of the prolapse

Urethral Prolapse - epidemiology

• Prepubertal girls <10 years of age
• Preponderance among African American females (90–100% of patients in reported series)
• Patients above average for height and weight

Urethral Prolapse - risk factors

Urethral Prolapse - genetics

Predominance in African American females indicates a hereditary pattern.

Urethral Prolapse - etiology

Etiology unclear; proposed theories include:

• Poor adherence between smooth muscle layers of the urethra
• Estrogen deficiency
• Female circumcision

Urethral Prolapse - DIAGNOSIS

Urethral Prolapse - signs & symptoms

Urethral Prolapse - history

• 95% present with bleeding/bloody spotting in underwear
• 21% have dysuria, frequency
• Occasionally, a patient presents with urinary retention.
• Some are asymptomatic and detected only incidentally.

Urethral Prolapse - physical exam

• Circular (doughnut-shaped) protrusion of urethral meatus with a reddish-purple mass filling the introitus with the urethral meatus at the center
• Tissue appears inflamed and friable.
• To help distinguish between a urethral and vaginal mass, the vulva can be retracted downward and laterally.
• The knee–chest position with the child supine can help visualize the anatomy.

Urethral Prolapse - tests

Urethral Prolapse - imaging

• If the appearance is atypical for urethral prolapse, ultrasound may be used to rule out bladder tumor (sarcoma botryoides) or prolapsed ureterocele.
• Urethral prolapse with typical presentation requires no imaging.

Urethral Prolapse - differencial diagnosis

• Prolapsing ureterocele (or ectopic ureter, urethral polyp, bladder)
• Sarcoma botryoides
• Condyloma
• Hydrometrocolpos
• Periurethral abscess
• Trauma

Urethral Prolapse - TREATMENT

Urethral Prolapse - general measures

• Do not try to manually reduce the prolapsed tissue.
• Conservative—sitz baths followed by topical estrogen cream twice a day
  • Some suggest topical antibiotics
• Surgical—most typical surgical approach is excision of prolapsed segment over a urethral Foley catheter, suturing the proximal urethral margin to the adjacent vestibule.

Urethral Prolapse - FOLLOW UP

Outpatient visit to assess success of estrogen cream or surgical repair

Urethral Prolapse - bibliography

1. Baldwin D, Landa H. Common problems in pediatric gynecology. Urol Clin North Am. 1995;22:173.
Kelalis P, King K, Belman A, eds. Clinical Pediatric Urology. Philadelphia: WB Saunders; 1992:653–654.
2. Lang ME, Darwish A, Long AM. Vaginal bleeding in the prepubertal child. CMAJ. 2005;172(10):1289–1290.
3. Shurtleff BT, Barone JG. Urethral prolapse: Four quadrant excisional technique. J Pediatr Adolesc Gynecol. 2002;15(4):209–211.
4. Valerie E, Gilchrists B, Frischer J, et al. Diagnosis and treatment of urethral prolapse in children. Urology. 1999;54:1082.

Urethral Prolapse - CODES

Urethral Prolapse - icd9

599.5 Prolapsed urethral mucosa

Urethral Prolapse - FAQ

• Q: What is the most common presenting complaint?
• A: Bleeding.
• Q: What is the “first aid” for this problem?
• A: Avoid infection and respect the tissue. Keep tissue moist. You may use antibiotic cream. Do not push the tissue back into the urethra.

Book Source Details

• Book Title: The 5-Minute Pediatric Consult
• Author(s): M. William Schwartz MD; et al.
• Year of Publication: 2008
• Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.

More About Urethritis

• Back to disease: Urethritis: Introduction
• Next Book Extract About Urethritis: Surveys relating to Urethritis
• More Book Extracts: All Online Books for Urethritis

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: The 5-Minute Pediatric Consult Authors: M. William Schwartz MD; et al. Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7577-9

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