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Urethral prolapse in children
E T Fernandes1, S Dekermacher, M A Sabadin
1Department of Pediatric Surgery, Hospital dos Servidores do Estado, Rio de Janeiro, Brazil.
Insights
Urethral prolapse in girls can be treated conservatively for mild cases or surgically via complete excision for best results. Surgical excision is recommended for persistent or severe cases of urethral prolapse.
Area of Science:
- Pediatric Urology
- Pediatric Surgery
Background:
- Urethral prolapse is a rare condition affecting girls, often presenting with vaginal bleeding.
- Predisposing factors include cough, trauma, and constipation.
- Contrary to previous reports, white girls comprised a significant portion of the patient cohort.
Purpose of the Study:
- To review the experience with urethral prolapse in a cohort of 23 girls.
- To evaluate different therapeutic approaches and their outcomes.
- To propose an evidence-based treatment strategy for urethral prolapse.
Main Methods:
- Retrospective review of 23 girls diagnosed with urethral prolapse.
- Analysis of presenting symptoms, predisposing factors, and demographic data.
- Evaluation of treatment outcomes for conservative management, ligation over a Foley catheter, and surgical excision.
Main Results:
- Vaginal bleeding was the most common symptom.
- Ligation over a Foley catheter resulted in a high rate of complications, including recurrence, infection, and pain, and is no longer utilized.
- Complete excision of the urethral prolapse yielded the best therapeutic outcomes.
Conclusions:
- Treatment decisions for urethral prolapse should be individualized based on the child's clinical condition and the prolapse's etiology.
- Conservative management is suitable for acute, single episodes of increased abdominal pressure or in high-risk anesthesia patients.
- Surgical excision is the preferred method for persistent cases or those unresponsive to conservative therapy.
Abstract:
We report our experience with 23 girls with urethral prolapse. Vaginal bleeding was the most common complaint, and predisposing factors (cough, trauma, and constipation) were found in 10 children. Although reported almost exclusively in black girls, 14 of the 23 patients were white. Three basic techniques were used for therapy: conservative management, ligation over a Foley catheter, and total excision of the prolapse. Ligation over a Foley catheter had a high incidence of complications (partial recurrence, infection, postoperative pain) and is no longer used. The best results were obtained by complete excision of the urethral prolapse. We propose that treatment should be based on the etiopathogenesis of the prolapse and the clinical condition of the child; patients with a single and acute episode of increased abdominal pressure, such as trauma, and those at high risk for general anesthesia are managed by conservative therapy. All others, and patients who fail medical treatment, undergo surgical excision.