Thank you Dr. Shin for today’s Morning Report!
Pediatric Urethral Prolapse
What is it?
- It is a protrusion of the distal urethra through the external meatus.
- Rarely diagnosed condition most common in prepubertal black females and post-menopausal white women.
- Urethral prolapsed is defined as the complete eversion of the terminal urethra from the external meatus.
Pathophysiology
Urethra is composed of inner longitudinal and outer circular-oblique smooth muscle layers. A prolapsed urethra may result from these 2 muscle layers separating after episodic increase in intra-abdominal pressure.- If left untreated may lead to strangulation and eventual necrosis of the protruding tissues
Presentation
Clinical Diagnosis
- Vaginal bleeding, Voiding disturbances, including obstruction, urinary frequency, dysuria, pain.
- Physical
- Doughnut shaped mass protruding form the anterior vaginal wall with congestion. Confirm with catheterization of central meatus.
Treatment
- Topical estrogen therapy- The distal urethra is estrogen-sensitive and may respond to treatment with estrogen, as in postmenopausal women with this problem.
- Sitz baths twice daily may also be helpful.
- If the distal urethra is necrotic, it may require surgery.
- If there is persistence of the prolapse, assessment for a urethral polyp may be indicated.
- Referral to GYN or pediatric GU for follow up, as definitive treatment may be surgical.
- May need biopsy to rule out sarcomas or endodermal sinus tumors.
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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