General Medical Information

Urethral Prolapse

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Prolapse of the urethra is a circular eversion of the urethral mucosa protruding through the meatus. It presents as a friable, red-blue annular mass. The mass may be ulcerated, infected, or even gangrenous. Careful examination will reveal the urethral meatus in the center of the mass and the vaginal introitus posterior to it. Visualization of voiding, catheterization, or cystourethroscopic examination may be required for diagnosis. The average age of presentation is 5 years. Most patients are African-Americans. Onset usually is sudden, and most patients present with painless vaginal bleeding. Dysuria, urinary frequency, or vulvar pain are other presenting features.

A history of genital trauma or increased abdominal pressure produced by crying, temper tantrums, coughing, or constipation has been associated with the onset of the prolapse. The etiology and pathophysiology remain obscure. Proposed etiologies include neuromuscular disorders, fascial defects, increased width of the urethra, urethral malposition, submucosal weakness, and elastic tissue deficiency.

Conservative measures include sitz baths, local care, and systemic antibiotics if infection coexists. Topical estrogens and antibiotics have been used. These measures are simple and effective, but the rate of recurrence is as high as 66%. Excision of the prolapsed mucosa with approximation of the mucosal edges is the most common approach and has the lowest complication rate. Cauterization and cryosurgery are other options for treating urethral prolapse in children.
Urethral polyps are a well-known entity in boys. Few cases of urethral polyps in girls have been reported. The polyp presents as an interlabial mass and usually arises in the posterior urethra. They may be asymptomatic or present with spotting. Urethral polyps are effectively treated by simple excision and fulguration of the base. No recurrences after excision have been reported.

Urethral caruncles are the most common benign tumors of the female urethra; most occur in postmenopausal women. Several cases of urethral caruncles in prepubertal girls have been reported, including one present at birth. The most common location for the growth is the posterior lip of the urethral meatus, but other locations have been reported. Urethral caruncles frequently are asymptomatic, but bleeding may be a presenting feature. Local care with sitz baths and topical estrogen cream are effective measures. Simple surgical resection provides a specimen for pathologic confirmation.