Urethral prolapse in girls

Abstract

Urethral prolapse is a benign lesion of the terminal urethra, usually seen in young Negroid girls. Twenty-seven children with urethral prolapse treated at the University Hospital of the West Indies between January 1982 and December 1991 were prospectively studied; 74% were between the ages of 3 and 7 years. Bloody discharge was the most common symptom. Vulval bleeding together with a bruised appearance of the urethra resulted in erroneous initial suspicion of sexual abuse in 3 children. Prolapse was graded from I to IV depending on the extent of prolapse and degree of inflammation. Initial therapy in the 25 prepubertal girls consisted of sitz baths and topical application of either an antimicrobial ointment (15 girls) or 0.5% oestrogen cream (10), chosen randomly. Complete resolution of the prolapse occurred in only 4 children, 3 of them from the oestrogen group. Although the oestrogen led to a better response, it also caused theliarchy in 2 girls. Three children who had only transient improvement and 2 post-pubertal patients had surgical excision of the prolapse. Post-excision there were no complications or recurrence of prolapse. Three girls who had improvement with non-operative therapy continued to have grade II prolapse even after puberty. Initial therapy of urethral prolapse in prepubertal girls can be non-surgical, however, when this fails to achieve resolution surgical excision is simple, safe, and curative.