Case report on the conservative management of a prepubertal girl with urethral prolapse

• Main Authors: Mohd Sakri, Noor Asikin, Ali Yeon, Amira Anis, Abu Ishak, Nurkhairulnisa
• Format: Article
• Language: English
• Published: Malaysian Medical Association 2023
• Subjects: RG Gynecology and obstetrics
• Online Access: http://irep.iium.edu.my/109981/1/109981_Case%20report%20on%20the%20conservative%20management.pdf; http://irep.iium.edu.my/109981/; https://www.e-mjm.org/2023/v78s1/index.html

Introduction: Urethral prolapse (UP) is a rare, benign condition that often goes misdiagnosed and mismanaged. It consists of the eversion of the distal urethral mucosa through the outer urethral meatus, leading to vascular obstruction and prolapsed tissue edema. It can be worrying to the parents as it often causes vaginal bleeding. Its cause is still unclear however estrogen deficiency may play a role. No investigation is necessary as its diagnosis is essentially clinical. Treatment of urethral prolapse ranges from conservative therapy to various surgical techniques. Case Description: A six-year-old girl presented with vaginal bleeding associated with dysuria. There were no other urinary symptoms. Genital examination showed a hyperemic circular mass above the vaginal introitus covering the urinary meatus with the size of 0.5 cm diameter and length with no active bleeding. After confirming the diagnosis of UP, a conservative treatment decided using daily application of estrogen cream. The examination after 2 months showed normal vaginal mucosa with no evidence of relapse. Discussion: UP is a rare condition occurring in prepubertal girls evidenced by a urethral mass and bleeding. Increased physician awareness and early recognition of UP avoids unnecessary examinations and treatment. Conservative management is an effective option. It aims to reduce mucosal oedema, improve local hygiene and counteract lack of estrogen using estrogen cream. This treatment is also effective in reducing patients and their parents’ anxiety. Surgical management can be reserved in failed conservative management.