[Urethral prolapse: an unknown diagnosis in pediatrics]

Urethral prolapse is defined as the protrusion of the distal urethral mucosa in a circular shape through the external meatus. It is a rare condition with an estimated incidence of 1 in 3,000 cases. It primarily affects prepubescent girls of African origin and postmenopausal women of Caucasian origin. While generally asymptomatic, this condition can also cause vaginal bleeding, dysuria, hematuria, urinary urgency, urinary retention and dyspareunia. The pathophysiology of this condition is debated. Increases in intra-abdominal pressure (e.g. coughing, constipation or trauma) and a hypo-estrogenic environment are the most common risk factors. In most cases, the diagnosis is clinical. It is important to consider the differential diagnosis, as this condition can include malignant pathologies (such as botryoid sarcoma and rhabdomyosarcoma), as well as sexual violence. Treatment is generally conservative for asymptomatic or paucisymptomatic cases, while more symptomatic or recurrent cases may benefit from surgery. This article presents the case of a three-year-old girl of African origin who was referred to the local Sexual Assault Center (SAC) for suspected sexual abuse, after vaginal bleeding of unknown origin was discovered upon her return from school.