Urethral Prolapse Research Articles

British Association of Urological Surgeons (BAUS) consensus document for the management of benign female urethral lesions.

To provide a consensus document for the management of benign female urethral lesions. The British Association of Urological Surgeons (BAUS) Female, Neurological and Urodynamic Urology (FNUU) Section created a consensus document to guide the management of the commonest of urethral swellings using expert consensus with a modified Delphi technique. Benign urethral lesions in females can include urethral mucosal prolapse, urethral caruncle, Skene's gland cysts and urethral diverticulum. They can present in a variety of ways including haematuria, lower urinary tract symptoms and voiding dysfunction, and can initially be overlooked or not recognised, resulting in delayed management. This consensus statement led by the FNUU Section of the BAUS, in consultation with BAUS members and consultants working in units throughout the UK, aimed to create a comprehensive and pragmatic management pathway for the assessment, investigation and treatment of benign urethral lesions in females.

Urethral prolapse in a 4-year-old girl: A case report

Background: Urethral prolapse is a rare cause of vaginal bleeding in prepubertal females and occursmore commonly in black girls. It is characterized by protrusion of the distal urethral mucosa at orbeyond the level of the urethral meatus. It is often mistaken for sexual abuse in children because itpresents with vaginal bleeding, creating anxiety among parents and confusion among clinicians.Case presentation: A 4-year-old girl presented to the outpatient department with a 2-day history ofvaginal bleeding. However, no lower abdominal pain was reported. Sexual abuse was initiallysuspected. A diagnosis of urethral prolapse was made during examination under anesthesia.Surgical excision and postoperative care were performed.Conclusion: Urethral prolapse, although rare, can occur in prepubertal black girls and is managedeither surgically or through conservative approaches.

A case report of urethral prolapse in young girls: Clinical manifestations and surgical management

Background and importanceUrethral Prolapse (UP), first described by Solinger in 1732, is a rare condition characterized by the circular protrusion of the distal urethral mucosa through the external meatus, forming a hemorrhagic, sensitive vulvar mass. This condition is most commonly observed in prepubertal black females. This case report details the clinical manifestations and surgical management of UP in three young girls. Cases presentationThree girls, aged 4, 5, and 6 years, were admitted with symptoms of vaginal blood spotting. Physical examinations revealed moderate bleeding and a red ring of congested, edematous tissue prolapsing through the urethral meatus. Diagnostic procedures confirmed UP, and surgical management was undertaken. The surgical approach involved the complete excision of the prolapsed tissue and mucosal-to-mucosal anastomosis under general anaesthesia. Postoperative follow-up over a mean period of 11 years showed no recurrence or urethral stricture. Clinical discussionUP is a rare benign condition primarily affecting the female urethra, with several hypothesized etiologies, including weak pelvic floor structures and increased intraabdominal pressure. The typical presentation includes vaginal bleeding and a doughnut-shaped mass around the urethral meatus. Conservative management may be considered for mild cases, but surgical excision is recommended for severe cases, offering a safe and effective solution with low recurrence rates. ConclusionsUP in children, although rare, should be considered in cases of unexplained vaginal bleeding. Diagnosis is primarily clinical, and surgical resection provides a definitive and cost-effective treatment.

Surgical treatment of canine urethral prolapse via urethropexy or resection and anastomosis.

The objective was to report and compare the complications and recurrence rates of urethral prolapse in dogs when treated with urethropexy, resection and anastomosis or a combined surgical technique. Retrospective study. A total of 86 dogs were identified from the medical records of 10 veterinary referral hospitals from February 2012 and October 2022. Dogs were included if they underwent surgery for a urethral prolapse at first presentation. Complications were classified as minor or major based on the necessity of further surgical intervention. Complications leading to death were also considered major complications. Seventy-nine dogs were included, urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications were identified in 41 of 79 dogs (51.9%): urethropexy 19 of 44 (43.2%), resection and anastomosis 18 of 27 (66.6%) and a combined surgical technique four of eight (50%). Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%). Recurrence of a urethral prolapse was significantly more likely following urethropexy in comparison to resection and anastomosis. Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy for the surgical treatment of urethral prolapse. Based on these results, we concluded that resection and anastomosis may be preferable to urethropexy for treatment of urethral prolapse at first presentation. Urethropexy, and resection and anastomosis combined surgical technique was associated with low recurrence rate; however, further studies will be needed to clarify if it provides any benefit over resection and anastomosis.

Management of thrombosed urethral prolapse in a premenopausal adult woman: case report and literature review

Management of thrombosed urethral prolapse in a premenopausal adult woman: case report and literature review

Urethral Prolapse in a Post-Menopausal Woman at the Sominé Dolo Hospital in Mopti (Mali)

Urethral mucosal prolapse is a rare and benign condition, which consists of a circular eversion of the distal urethral mucosa through the urinary meatus. It occurs most often in prepubertal and postmenopausal women for whom lack of estrogen and poor pelvic support remain the predisposing factors. Its presence in the post-menopausal period is rare. We report a case of urethral prolapse in a postmenopausal woman at the Sominé Dolo hospital in Mopti who presented with persistent urinary symptoms. We present a case of urethral prolapse observed in a 66-year-old woman referred to the urology consultation and who presented recurrent urinary symptoms with multiple treatments based on antibiotics and medicinal plants without success for a year. Physical examination noted a circular, non-reducible and non-painful swelling at the level of the urethral meatus with bleeding on contact, consistent with urethral prolapse. The option of surgical excision was discussed with the patient. The patient underwent surgery and the postoperative course was simple.

FRI509 A Girl With Trisomy 21 Presents With Van Wyk-Grumbach Syndrome

Abstract Disclosure: J. Hayes dorado: None. M. Calla Ayala: None. A. Colque Arias: None. K. Lanuza Gaite: None. M. Rossell Lopez: None. D. Frias Eid: None. Van Wyc-Grumbach syndrome (VWGS) is a rare presentation of long standing prepubertal hypothyroidism characterized by bilateral multicystic enlarged ovaries, vaginal bleeding and delayed bone age. It appeared that high TSH could produce FSH and LH like activity leading to multiple ovarian cysts. A 7-year-old girl with trisomy 21, presented with vaginal bleeding for 2 days prior to admission. Physical exam revealed bradycardia (68 bbm), apathy, sluggishness, as well as dry skin and eyelid oedema. She had no breast development nor pubic hair.Causes of vaginal bleeding such as trauma, possible abuse, foreign body insertion and urethral prolapse were excluded. There was no purpura or bleeding from other sites.The abdominal sonogram revealed bilateral ovarian cystic masses (V:17.29 cm3 and 16.48 cm3, right and left, respectively). Bone age was delayed almost 3 years behind her chronological age. Laboratory tests revealed TSH 860 μIU/mL, T4 0.71 μg/dL, FSH 8.12 mIU/mL, LH < 0.1 mIU/mL, estradiol 193 pg/mL, thyroid peroxidase Abs 184 IU/mL, thyroglobulin Abs 212 IU/mL, Β-hCG < 0.1mU/mL, confirming severe hypothyroidism. The girl was diagnosed with VWGS due to unrecognized chronic lymphocytic thyroiditis and LT4 treatment (75mug/OD) was initiated. The patient responded with complete remission of symptoms and regression of the ovarian cysts one month after initiation of treatment. It is very important to think of VWGS and investigate for thyroid status during the evaluation of ovarian cysts or isolated premature menarche. Early recognition can eliminate unnecessary surgery to remove ovarian cysts, as appropriate treatment with levothyroxine leads to complete remission of symptoms. Even when the diagnosis of VWGS is confirmed, practitioners must be watchful to consider surgical intervention in the presence of uncontrolled vaginal bleeding, hemodynamic instability, or failure of regression of ovarian cysts with exogenous thyroid hormone replacement. Presentation: Friday, June 16, 2023

Evaluation and management of urethral and periurethral masses in women.

Female periurethral masses are an uncommon occurrence. The purpose of this review is to describe etiologies of female urethral and periurethral masses and to provide an update on diagnosis and management. The most common causes of periurethral and urethral masses in women are urethral caruncles, urethral diverticula, and Skene's gland cysts. Urethral meatal lesions such as urethral caruncles and prolapse can be managed conservatively with topical estrogen therapy and close follow-up or should be excised in the setting of thrombosis, significant or recurrent bleeding, acute urinary retention, or persistent pain. Benign periurethral gland masses, such as Skene's gland cysts, Gartner's duct cysts, and Mullerian duct cysts, remain rare. Recent case series reveal a high rate of surgical management of these lesions with few complications. Urethral malignancy or malignant transformation of benign etiologies are even rarer but can be aggressive in nature and should be treated promptly. Nonspecific urinary and vaginal symptoms as well as similar physical presentations make diagnosis of urethral and periurethral lesions in females difficult. Magnetic resonance imaging is useful for differentiation of periurethral masses. The decision for conservative or surgical management is typically guided by patient symptom bother, as well as concern for urethral malignancy.

Four vertex technique for correcting urethral prolapse: technique description and cohort study.

This study aims to describe the procedure and effectiveness of the four-vertex technique for correcting urethral prolapse in women. includes a retrospective case series of 17 patients who underwent surgery for urethral prolapse. Two study groups were distinguished based on the presence or absence of pelvic heaviness symptoms. The variables were analyzed, including age, BMI, concomitant diseases, obstetric and gynecological history, time from diagnosis to surgery, and outcomes of treatment. All patients were postmenopausal, with a mean age at the time of the intervention of 70.41 years, with no differences between groups. Mean BMI was 23.67 kg/m2, higher in the group with a sensation of vaginal heaviness (p = 0.027). Mean time elapsed between diagnosis and operation was 231.58 days, with no differences between groups. Mean childbirth count was 2.29. The most frequent causes for consultation were urethrorrhagia (33.33%) and a bulging sensation (33.33%). After the intervention, 14 patients (82.35%) were asymptomatic, two (11.76%) had dysuria, and one (5.88%) had urinary urgency. Ten patients had pre-surgical urinary incontinence, which was resolved in nine patients. 17.46% subsequently presented pelvic organ prolapse. In three women there was secondary impairment of sexual activity. The four-vertex technique was effective in resolving symptoms in most patients. However, some patients experienced dysuria, urinary urgency, and pelvic organ prolapse after surgery. Urinary incontinence improved in most patients, but a few required additional treatments with suburethral tape. The study also identified associations between variables and the presence of cystocele, consultation for a bulging sensation, and bleeding from urethral prolapse. Overall, this study sheds light on the challenges and outcomes of surgical treatment for urethral prolapse and provides valuable insights for future research in this area.

Usefulness of uroflowmetry for the management of urethral prolapse in a prepubertal girl

Usefulness of uroflowmetry for the management of urethral prolapse in a prepubertal girl

The spectrum and etiologies of lower urinary tract symptoms in postmenopausal women.

Although the prevalence of lower urinary tract symptoms (LUTS) is high in the female population, it is even higher in postmenopausal females. The frequency, severity, and etiology of LUTS vary among populations and individuals. This study aimed to define the characteristics of LUTS in postmenopausal women and their underlying etiologies. Overall, 74 postmenopausal patients presenting with LUTS in the urological outpatient department were included in the study. A detailed evaluation of LUTS and their underlying etiologies was performed. Patients were divided into 2 groups based on age (<65 and ≥65 years), and the variation in different factors was compared across the groups. Variables were compared using the t test and 1-way analysis of variance. Nocturia was the most common symptom (89.2%) followed by frequency (83.8%). Among voiding LUTS, the most common was a weak stream (63.5%). Frequency, nocturia, urgency, urge urinary incontinence (UI), stress UI, and nocturnal enuresis were more common in patients older than 65 years. Urgency and urge UI were recognized to be the most bothersome symptoms by 37% of the study population followed by straining (32%). The mean storage scores, incontinence scores, and quality of life (QoL) scores for patients younger than 65 years and 65 years or older were 6.9 and 8.5 (p < 0.01), 1.8 and 4.1 (p ≤ 0.01), 4.9 and 6.1, respectively. The most common diagnosis was bladder outlet obstruction due to urethral/meatal stenosis (40.5%) followed by an overactive bladder (32.4%), urinary tract infection (10.8%), cystocele (8.1%), urethral prolapse (4.1%), and urethral caruncle (4.1%). Storage LUTS were the most common and increased in both frequency and severity with age. The QoL was also more severely affected in older postmenopausal women. Bladder outlet obstruction due to meatal with or without distal urethral stenosis was the most common underlying cause of LUTS followed by an overactive bladder. Overactive bladder had the most severe impact on patients' QoL among all the etiologies.

Surgical evaluation and management of urethral prolapse

Surgical evaluation and management of urethral prolapse

Vaginal bleeding in children: A retrospective audit at a tertiary paediatric gynaecology service.

The aim of this study was to describe the clinical features and investigations of vaginal bleeding in prepubertal children. We performed a retrospective case series of children under the age of 10 who presented with vaginal bleeding to our institution between 2018 and 2019. There were 32 cases identified during the timeframe, with a mean age of 5.5 years (standard deviation 3.2 years, range 5.5 days to 9.6 years). Vulvovaginitis was the most common diagnosis (n=12, 37.5%), followed by precocious puberty (n=5, 15.6%). Uncommon but serious causes were vaginal rhabdomyosarcoma (n=1), and sexual abuse (one patient presenting with gonorrhoea and one with a non-accidental injury). Vaginoscopy was performed in nine patients (28.1%) for various reasons, and a vaginal foreign body was identified in two patients (6.3%). All the patients who had a serious cause of bleeding (neoplasm or sexual assault) or who required specific treatment (precocious puberty, lichen sclerosus, urethral prolapse) presented with red flags on history and/or examination: recurrent episodes of vaginal bleeding, heavy bleeding, associated general symptoms (poor feeding and growth), presence of thelarche, abdominal mass, associated profuse vaginal discharge and abnormal genital examination (skin changes, urethral prolapse or protruding mass from the vagina). A thorough history-taking and clinical examination aiming at identifying red flags may help to discriminate between benign causes of vaginal bleeding, where no further investigations are indicated, and alternative diagnoses with a poor outcome and/or requiring specific treatment and additional investigations.

Paediatric interlabial bleeding: More than vaginal pathology

A 10 years old girl was referred with the complaints of “per vaginal bleeding and a mass after cycling”. During the first 2 weeks of symptoms, she had visited three different doctors with possible delayed recognition of her diagnosis. Clinical examination revealed an underweight, non-dysmorphic, prepubertal girl with vulvitis and an inflamed interlabial bleeding mass with ulceration. Imaging revealed a subcentimetre arteriovenous fistula and haematoma in the vagina. After one more week (total 3 weeks) of medical therapy, the indication for surgery was worsening of symptoms and failure of medical management. Examination under anaesthesia and cystoscopy revealed a complete urethra prolapse. Dilute adrenaline was injected into the prolapsed mucosa. The prolapse was excised in elliptical segments, and the edges closed with interrupted absorbable sutures. Sub-centimetre segments of mucosa were left between the excised specimens. Bipolar diathermy was used only for hemostasis and circumferential coagulation on the mucosa was avoided. These measures prevent an iatrogenic stenosis. The urethra prolapse was reduced, with no recurrence demonstrated on Valsalva maneuver. Post-operatively, her symptoms resolved. Oral antibiotics, sitz baths, antimicrobial cream and topical estrogen were administered. There was no recurrent urethra prolapse or stricture. The aim of this case report is to increase awareness of the urethral prolapse in the paediatric population and its management.

8445 Surgical Management of Urethral Prolapse: A Case Report

<h3>Study Objective</h3> To describe a case of acute urethral prolapse presenting with refractory pain and urinary retention, and to demonstrate surgical management, delineating key surgical steps using a surgical video. <h3>Design</h3> Case report demonstrated in a narrated surgical video <h3>Setting</h3> Patient presented to an academic hospital emergency department and required emergent surgical management in the operating room. In the operating room, patient is positioned in dorsal lithotomy with LoneStar retractor in place. <h3>Patients or Participants</h3> This surgical video describes a case report of a 45-year-old perimenopausal female who presented with acute onset refractory pain and urinary retention, as well as inability to tolerate catheterization, secondary to acute urethral prolapse with thrombosis and necrosis. <h3>Interventions</h3> After appropriate patient positioning, healthy urothelium was identified with cystourethroscopy above the prolapsed tissue. Next, normal appearing urothelium was tagged proximal to the prolapse at 3 o'clock, 6 o'clock and 9 o'clock using interrupted 4-0 Vicryl sutures so that this healthy tissue would not retract once the prolapse was excised. The base of the prolapsed portion of the urethral was injected with 1% lidocaine with epinephrine. The prolapsed portion was excised with Bovie electrocautery in quadrants around the urethra. A 16 French transurethral Foley catheter was placed, and the balloon inflated. Normal healthy appearing urothelium was re-approximated to the external urethral meatus epithelium using interrupted 4-0 Vicryl sutures with repair of one quadrant at a time. This was performed over the Foley catheter to ensure patency and prevent stricture. <h3>Measurements and Main Results</h3> The patient presented in this surgical video had immediate and complete resolution of symptoms. <h3>Conclusion</h3> Urethral prolapse rarely requires surgical intervention; however, when surgical treatment of urethral prolapse is necessary, it can be effective with appropriate surgical technique.

Urethral Pathology in Women.

This paper describes the differences in benign, malignant, and iatrogenic urethral pathology in women and reviews common presenting symptoms and management strategies. The advancement of magnetic resonance imaging has led to MRI becoming the imaging modality of choice for urethral pathology. Urethral pathology is rare, and there remains a paucity of evidence-based literature for management. Urologists and gynecologists must be familiar with common benign urethral pathology, the most common of which includes urethral diverticula, Skene's gland cyst, urethral prolapse, and caruncle. Further case series are providing further insights to the management of these rare entities. Urologists and gynecologists must understand the most common urethral pathologies and be able to identify the most appropriate treatment approach. It is essential to be able to differentiate these entities from malignancy and obtain a thorough surgical history to identify possible iatrogenic causes.

An Unusual Cause of Vulvar Hemorrhage: About 12 Cases

Vulvar or genital hemorrhage is an alarming reason for consultation that worries parents a lot. Several etiologies of vulvar bleeding have been reported, including sexual abuse (common in our socioeconomic context) or urethral prolapse. Urethral prolapse is the complete eversion of the distal congestive urethral mucosa through the urinary sphincter. It is a benign condition that is uncommon in children and occurs in girls with a peak in frequency between the ages of four and six, mainly in the black population. The clinical presentation is dominated by vulvar bleeding, which therefore poses a medico-legal issue and a differential diagnosis with other causes of genital hemorrhage. The diagnosis is purely clinical, presenting as a more or less voluminous pink or purplish edematous circumferential pseudotumor bulge that bleeds spontaneously. No paraclinical examination is necessary. We retrospectively analyzed the records of 12 prepubertal patients aged between 5 and 12 years who consulted for genital hemorrhage either post-traumatic or spontaneous with urethral prolapse in the Pediatric Surgical Emergency urethral prolapse department, over a period of 18 years (1998 - 2020). In our series, the age of diagnosis ranged from 5 to 12 years with a median age of 08 years. Eleven patients were Caucasian and only one patient was from Senegal. Other causes of vaginal hemorrhage were ruled out, including sexual abuse or post-traumatic bleeding. The treatment of this affection is subject to great controversy, between surgical and conservative treatment, all our patients benefited from surgical treatment except one patient who benefited from medical treatment. The risk of complications, in particular urethral stenosis and recurrence, is not negligible in the face of poorly conducted medical treatment or surgery. In our series, the clinical outcome was favorable in all patients. The duration of hospitalization could be shortened by an early removal of the urinary catheter, .......

Case report. Successful conservative treatment in a symptomatic postmenopausal woman with a urethral prolapse

AbstractA 75 years old female presented at the department of Urology with vaginal bleeding, urinary tract symptoms and a protruding mass. Pelvic examination showed a urethral prolapse. There was no recurrence of the urethral prolapse after a combination of manual reduction, a pessary, a transurethral catheter for 10 days and estrogen cream for three months. Literature describes some cases concerning conservative treatment in women with symptomatic urethral prolapse. The best reasonable treatment option for this group of women would be surgical excision. This case report shows a symptomatic urethral prolapse in a post-menopausal woman with good results after non-surgical treatment, a combination of manual reduction, a transurethral catheter and a pessary, with a follow up of eight months.

Conservative management of urethral prolapse in African girls: a report of 15 cases

BackgroundUrethral prolapse is a rare disease, mainly occurring in African prepubertal girls. Its etiology remains unclear; however, some risk factors have been reported. The diagnosis is made clinically. The treatment can be conservative or surgical.MethodsWe report our experience in the service of pediatric surgery at Albert Royer National Children’s Hospital Centre. We conducted a retrospective descriptive cross-sectional study, on which considered patients were managed for urethral prolapse in our service from 2014 to 2019.ResultsOur study has included 15 girls whose mean age was 4.08 years (1.17–10). Two risk factors (chronic cough and constipation) were found in 20%. Genital hemorrhage was the main symptom (73.3%), and suspicion of sexual abuse was documented in 13.3%. The clinical finding was classical (donut-shaped vulvar mass) in all patients. All patients underwent conservative management, which was successful in 73.3%. Patients with failed conservative management were treated surgically by resection of the prolapsed mucosa on a Foley catheter. No complication was reported after surgical treatment, and after a 13-month mean follow-up, no recurrence was reported in all patients.ConclusionsConservative management is an efficient option for urethral prolapse. It has the advantage of avoiding general anesthesia with its potential complications and restricted availability in sub-Saharan Africa. Surgical management should be reserved for failed conservative management.

14 - A rare case of a necrotized urethral prolapse in a postmenopausal woman with acute urinary retention

14 - A rare case of a necrotized urethral prolapse in a postmenopausal woman with acute urinary retention