Clinical characteristics of urethral prolapse in Japanese children.

Abstract

Urethral prolapse (UP) in children is a rare condition and has commonly been reported in black girls. The aim of this study was to clarify the status of medical management for UP in Japanese children. A secondary data analysis was conducted in Japanese children ≤15years old with UP. The relationship between initial treatment approach and outcome was investigated, with symptom persistence or recurrence defined as treatment failure. Of 77 cases of UP in Japanese children reported since 1972, initial surgical treatment was performed in 42 cases (55%) and non-surgical treatment in 35 cases (45%). Underlying conditions constituting possible causative factors were present in 26 cases (34%) in total. Treatment outcome was evaluated in 59 cases (surgical treatment, n=28; non-surgical treatment, n=31) during a median follow-up period of 10months. The rate of treatment failure was significantly higher in the non-surgical (81%, 25/31) than in the surgical treatment group (18%, 5/28; risk ratio, 4.2; 95%CI: 2.0-8.9; P<0.001). Topical estrogen cream, a standard management worldwide, is not available as a prescription drug in Japan, and therefore was able to be used in only seven cases (20%) in the non-surgical treatment group. Surgical treatment is more effective than non-surgical treatment in Japanese children, but both failure rates are high compared with that in non-Asian children. Drug approval revision for prescription use of estrogen cream, centralizing treatment to specialized facilities, and an active policy of surgical management in cases of non-surgical treatment failure may improve treatment outcomes for pediatric UP in Japan.