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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.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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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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