Urethral prolapse, also known as urethrocele, is a very rare condition most often found in prepubescent girls. The likelihood of this condition happening is about 1 out of every 5,000 girls. Urethral prolapse is when the urethra protrudes from the urinary opening and is not life-threatening. It has been reported in several countries around the world, but its rarity often leads to misdiagnosis and thus a delay in treatment.
What Is Urethral Prolapse?
Urethral prolapse is a condition where the inner lining of the urethra protrudes from the urinary opening. The urethra is an organ shaped like a tube that carries urine from the bladder to outside of your body. In females, the urethra is short and extends from the bladder to the front of the vagina. When the inner lining of the urethra sticks out, it looks like a pink doughnut that’s larger than normal in size.
Urethral prolapse only occurs in females and is most common in young girls before puberty and in postmenopausal Caucasian women. The condition has been diagnosed in girls ranging from 5 days old to 11 years old. African American and Hispanic girls are more likely to be affected by urethral prolapse.
Urethral prolapse is one type of benign, or noncancerous, urethral lesions in girls. It's different from urethral caruncles, a condition where stalklike masses, or polypoids, hang from part of the urethral opening.
What Are the Causes of Urethral Prolapse?
Urethral prolapse causes are not known, but risk factors include genetic predisposition, chronic cough, constipation, and urinary tract infection (UTI), and increased weight. All of these factors increase the pressure inside the abdomen, which may lead to urethral prolapse. Other contributing factors include malnutrition, trauma, increased weight, and physical exertion.
Urethral prolapse is also thought to occur when the tissues around the urethra are weak or when the muscles there fail to connect solidly to the urethral skin. This is most often the case for girls before puberty when their estrogen levels are low. This condition is found more often in prepubescent African American girls aged 5 to 8 years old. Fewer than 1 in 10 cases occur in Caucasian girls.
What Are the Symptoms of Urethral Prolapse?
Nearly 10% of people who have urethral prolapse will not show any symptoms. If there are urethral prolapse symptoms, the most common one is vaginal bleeding and bloody spotting. The area near the protrusion may be tender for some people, especially after wiping themselves post-urination.
Other than irritation around the local area, the prolapsed tissue itself is usually not tender, unless the urethral prolapse has lasted for a while and the protrusion becomes swollen or an open sore.
Some people may experience painful urination or difficulty emptying the bladder, also known as urinary retention syndrome. Hematuria, or the presence of blood in the urine, is common in postmenopausal women but not in prepubescent girls.
How Is Urethral Prolapse Diagnosed?
Since many people who experience urethral prolapse don’t show any symptoms, diagnosis may be delayed. Additionally, urethral prolapse is sometimes misdiagnosed because of the condition’s rarity.
Urethral prolapse is most often found during routine physical exams. The diagnosis is essentially clinical, as observations can be made of the pinkish or purplish round tissue protruding from the urethral opening. The urologist may order a pelvic ultrasound or watch the urine stream flow through the prolapsed urethra. This is to more accurately diagnose the condition, since urethral prolapse is misdiagnosed as vaginal bleeding in 1 out of 5 cases.
A voiding cystourethrogram (VCUG) can also be used to diagnose urethral prolapse. A VCUG uses a special X-ray technology to see the child's urinary tract and bladder. It's a minimally invasive test that can be used to better observe the protruding urethral tissue.
What Are Treatment Options for Urethral Prolapse?
In mild cases of urethral prolapse, no treatment may be needed. Treatment can range from conservative to surgical depending on the severity. Urethral prolapse treatment include:
- Estrogen cream. This is usually the first type of treatment to be used. The use of estrogen cream may lead to some side effects, including the development of pubic hair, breast development, and general irritation. The side effects may go away after you stop using the cream.
- Vaseline. You can also apply vaseline around the affected area to ease the irritation. Vaseline acts as a barrier to help alleviate some of the sensitivity resulting from the urethral prolapse.
- Sitz baths. You can sit in a warm, shallow sitz bath for 15 to 20 minutes to soothe the urethral prolapse area and keep it clean to help with the healing.
- Antibiotics. In cases where the urethral prolapse may be caused by a vaginal or urinary tract infection, taking antibiotics can fight the infection and help with healing.
- Surgery. For cases where symptoms still don’t go away after trying the other treatments, surgery may be needed to take out the prolapsed tissue. Afterward, the membrane is stitched back together to keep the protrusion from happening again. A urinary catheter may be placed inside the bladder before the surgery to help with draining urine from the bladder. The catheter can be taken out after a day or two. There may be some bloody spotting or painful urination the first few days after surgery, but that should go away soon.
The most common treatment is to first apply estrogen cream and use sitz baths for two weeks. In most cases, the condition should go away within weeks of treatment. A urethral protrusion that is bluish or purplish and is tender usually indicates that surgery is needed.
Urethral prolapse is a rare condition that is non-life-threatening and generally simple to treat once it’s diagnosed. The condition is most common in prepubescent girls and postmenopausal women. African American and Hispanic girls are more at risk of being affected by urethral prolapse. There are no known causes, but risk factors include family traits, chronic cough, trauma, constipation, vaginal and urinary tract infection (UTI), and increased weight. Urethral prolapse may be irritating but does not usually affect your overall health too much. Most treatments are noninvasive, and surgery is only needed in the most serious cases.