Urethral prolapse is rare. It occurs most commonly in prepubertal black females and postmenopausal white women. Symptoms such as vaginal bleeding and urinary complaints are common in postmenopausal women, but children are frequently asymptomatic. A large prolapse may become strangulated and result in pain, bleeding, and urinary symptoms. Examination reveals a protrusion of the distal urethra through the meatus that appears as a donut-shaped mass at the anterior vaginal wall. Diagnosis is confirmed on identification of the urethral meatus as the central opening in the prolapsed tissues. Urethral catheterization may be required if direct observation during voiding is not possible.
Management and Disposition
Rule out urinary tract infection, which is frequently associated with urethral prolapse. Consult urology emergently for signs of urethral strangulation. Medical therapy consists of sitz baths and topical estrogen cream applied two to three times to the urethra for 2 weeks. Surgical therapy is reserved for strangulation or failed medical therapy. Refer all patients with confirmed or suspected urethral prolapse to a urologist for follow-up.
Urethral Prolapse. Note the protrusion of the distal urethra, seen as a donut-shaped mass at the anterior vaginal wall. (Photo contributor: Lawrence B. Stack, MD.)
Topical estrogen cream may be contraindicated in patients with a history of breast cancer.
Urethral prolapse in children may be mistaken for sexual abuse (see Chapter 15).
Urethral masses may be misdiagnosed as urethral prolapse.
Urethral Prolapse. Protrusion of the distal urethra is seen as a donut-shaped mass just superior to the vaginal introitus in a patient complaining of “vaginal bleeding.” (Photo contributor: Lawrence B. Stack, MD.)