Conservative approach for the treatment of urethral prolapse in children: case report and literature review of 278 pediatric cases

Background Urethral prolapse (UP) is a rare, benign condition that often goes misdiagnosed and mistreated. It consists of the eversion of the distal urethral mucosa through the outer urethral meatus, leading to vascular obstruction and prolapsed tissue edema, which aggravates the prolapse. Although many review articles were reported on this condition, none of them focused on the conservative approach nor targeted the pediatric population. In this paper, we present successful medical management of UP in a 13-month-old Caucasian female and perform an extensive review of the literature to include articles that reported a conservative approach in patients under 18-years-old. We also suggested a practical algorithm for both diagnosis and management of this condition. Case presentation A 13-month-old Caucasian white female was presented with a urinary tract infection and vaginal bleeding. Genital examination showed a hyperemic donut-shaped mass covering the urinary meatus, of 0.7 cm diameter, with an actively bleeding open center. After confirming the diagnosis of UP with catheterization, a conservative approach was decided; antibiotics associated with topical corticosteroids including betamethasone 1% cream. The first-week outcome showed regression of the prolapsed tissue and the examination after four months showed normal vaginal mucosa with no evidence of relapse. Conclusions 20 studies were retained after PubMed search with a total of 278 female patients aged between 1 month and 15 years old. The main reasons for referral were vaginal bleeding and mass, urinary symptoms followed by sexual abuse. Non-surgical treatment was tried for 162 patients. 53 of them were successfully managed, while 92 reported unsuccessful outcomes. The conservative approach was successful in 19% of all patients and raised to 32.7% in the portion of children selected for the initial conservative approach. Even though this review showed good results with medical treatment in children with UP, additional comparative studies are required to evaluate the effectiveness of conservative treatment in comparison with surgical interventions. In addition, Long-term follow-up is required as recurrence was reported up to 2 years following conservative treatment.

Urethral Prolapse in Prepubertal Girls in Port Harcourt, Nigeria: A Multicentre Study

Background: Urethral mucosa prolapse is a rare condition mainly seen in prepubertal girl with racial predilection for black girls. Methodology: This was a multicenter 7-year retrospective analysis of 27 cases of urethral mucosa prolapse treated at the university of Port Harcourt teaching hospital and private health facilities in Port Harcourt from 2011-2018. Relevant information extracted from the case files include age, clinical presentation, examination findings, treatment modality and post-operative complications. Data was entered and analyse using SPSS version 25 and results were presented in simple percentages and frequency tables Results: The institutional prevalence of urethral prolapse was 0.14%. The commonest presenting complaint was blood stains on the underwear in 23 (85.2%) patients while all patients presented with the characteristic ‘doughnut sign’ of a circumscribed fleshy mass surrounding the urethral meatus. All patients had intact hymen. Surgery was the primary treatment modality in 24 (88.9%) cases while conservative medical management was carried out in three (11.1%) patients. The success rate for surgical management was 100% and 33.3% for medical treatment. The commonest post-operative complication was dysuria reported in 7 (25.9%) cases and acute urinary retention was reported in one (3.75) patient. Conclusion: Urethral mucosa prolapse is a rare but important condition in prepubertal girls presenting with vaginal bleeding due to the suspicion of sexual abuse. Surgical treatment offers better outcome amongst the studied population.

Bladder Papilloma As A Rare Cause Of Urogenital Bleeding In A Prepubertal Girl

There are different causes of urogenital bleeding in prepubertal girls. These include vulvovaginitis, urinary infections, urethral prolapse, urethral caruncle, vaginal foreign bodies, hormonal causes, tumors, posterior labial fusion, lichen sclerosis. Among the tumors, rhabdomyosarcoma and papilloma are prominent. In this article, a case of urogenital hemorrhage due to papilloma located at the base of the bladder was presented and the relevant literature was reviewed

Thrombosed Urethral Prolapse: a case series and review of the literature

Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature. Level of Evidence: Level 4

Rare (uro-)genital pathologies in young girls mimicking sexual abuse

Examinations of young children for suspicions of sexual abuse are challenging for the involved medical specialists because the consequences of the interpretation of the findings can be severe and dramatic. A broad knowledge of differential diagnoses including rare pathologies like urethral prolapse and failure of the midline fusion of the perineum, known as perineal groove, is essential in order to avoid unnecessary diagnostics and treatment, prejudgment, and to reduce patient family’s anxiety. We report two independent cases of girls aged 7 months and 5 years suffering from these rare pathologies, one presenting with painless lower genital tract bleeding, the other showing a lesion of the perineum as random finding during a neuropediatrician’s consultation. In both cases, the pathologies were initially misdiagnosed as injuries due to sexual assault, and judicial investigation procedures were initiated. In this paper, the characteristic symptoms and morphology of urethral prolapse and perineal groove are presented to enhance the awareness of these pathologies among forensic experts and help to establish the correct diagnosis.

Urethral prolapse- case report and photographs

A report on menopausal age group urethral prolapse with illustrative photographs, its treatment and related literature review is presented.