eMedicine Specialties > Pediatrics: Surgery > Urology

Urethral Anomalies and Urethral Prolapse: Differential Diagnoses & Workup

Author: Jyoti Upadhyay, MD, FAAP, Consulting Staff, Children's Surgical Specialty Group, Children's Urology, Children's Hospital of the King's Daughters, Sentara Norfolk Hospital, Sentara Leigh Hospital
Coauthor(s): Carlos A Angel, MD, Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group
Contributor Information and Disclosures

Updated: Oct 15, 2008

Differential Diagnoses

Child Abuse & Neglect: Sexual Abuse
Urinary Tract Infection
Rhabdomyosarcoma
Voiding Dysfunction
Rhabdomyosarcoma: Surgical Perspective
Ureteral Duplication, Ureteral Ectopia, and Ureterocele
Urethral Anomalies and Urethral Prolapse

Other Problems to Be Considered

Prune belly syndrome
Urinary incontinence
Vaginal tumors (rhabdomyosarcoma)
Dysfunctional vaginal bleeding
Vaginitis
Bladder rhabdomyosarcoma
Urethral papilloma

Workup

Laboratory Studies

  • Perform a complete urinalysis and urine culture for any child who presents with symptoms suggestive of a urinary tract infection (UTI).1
  • Hematuria in the absence of infection and the evaluation of urinary incontinence are beyond the scope of this article but merit thorough investigation (see Hematuria, Urinary Incontinence).
  • In cases of urethral prolapse, obtaining a culture from the prolapsed mass or from any associated vaginal discharge may be useful.

Imaging Studies

  • Study all patients with culture-proven UTIs using a voiding cystourethrography (VCUG) and a renal and bladder ultrasonography.
  • In the absence of UTIs, most suspected urethral lesions can be documented with a VCUG or retrograde urethrography (RUG).2
  • Evaluation of the upper tracts with ultrasonography, nuclear scanning, or intravenous pyelography is particularly important in patients with anterior urethral valves, urethral duplications, megalourethras, urethral diverticula, polyps, or Cowper duct cysts because various degrees of obstructive uropathy may be present and may affect the upper urinary tract and kidneys.
  • In patients with megalourethras and urethral duplications, additional imaging studies may be necessary due to the high incidence of associated anomalies.
  • Patients with urethral prolapse do not require further evaluation of their urinary tracts. However, if the diagnosis is in question, performing bladder ultrasonography to exclude a bladder rhabdomyosarcoma is reasonable.

Procedures

  • Cystoscopy can be used to clarify a diagnosis or for therapeutic purposes.

More on Urethral Anomalies and Urethral Prolapse

Overview: Urethral Anomalies and Urethral Prolapse
Differential Diagnoses & Workup: Urethral Anomalies and Urethral Prolapse
Treatment & Medication: Urethral Anomalies and Urethral Prolapse
Follow-up: Urethral Anomalies and Urethral Prolapse
References
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References

  1. AAP. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics. Apr 1999;103(4 Pt 1):843-52. [Medline].

  2. Goldman M, Lahat E, Strauss S, et al. Imaging after urinary tract infection in male neonates. Pediatrics. Jun 2000;105(6):1232-5. [Medline].

  3. Rushton HG, Parrott TS, Woodard JR, Walther M. The role of vesicostomy in the management of anterior urethral valves in neonates and infants. J Urol. Jul 1987;138(1):107-9. [Medline].

  4. Agarwal S, Lall A, Bianchi A, Dickson A. Uro-genital bleeding in pre-menarcheal girls: dilemmas of child abuse. Pediatr Surg Int. Jun 2008;24(6):745-6. [Medline].

  5. Johnson CF. Prolapse of the urethra: confusion of clinical and anatomic characteristics with sexual abuse. Pediatrics. May 1991;87(5):722-5. [Medline].

  6. Anveden-Hertzberg L, Gauderer MW, Elder JS. Urethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls. Pediatr Emerg Care. Aug 1995;11(4):212-4. [Medline].

  7. Bartone FF. The urethra. In: O'Donnell B, Koff S, eds. Pediatric Urology. 3rd ed. Butterworth-Heinemann; 1994:526-36.

  8. Casale AJ. Posterior urethral valves and other obstructions of the urethra. In: Gonzales ET, Bauer SB, eds. Pediatric Urology Practice. Lippincott Williams & Wilkins; 1999:240-4.

  9. Fernandes ET, Dekermacher S, Sabadin MA, Vaz F. Urethral prolapse in children. Urology. Mar 1993;41(3):240-2. [Medline].

  10. Jerkins GR, Verheeck K, Noe HN. Treatment of girls with urethral prolapse. J Urol. Oct 1984;132(4):732-3. [Medline].

  11. Lowe FC, Hill GS, Jeffs RD, Brendler CB. Urethral prolapse in children: insights into etiology and management. J Urol. Jan 1986;135(1):100-3. [Medline].

  12. Rudin JE, Geldt VG, Alecseev EB. Prolapse of urethral mucosa in white female children: experience with 58 cases. J Pediatr Surg. Mar 1997;32(3):423-5. [Medline].

  13. Schoellnast H, Lindbichler F, Riccabona M. Sonographic diagnosis of urethral anomalies in infants: value of perineal sonography. J Ultrasound Med. Jun 2004;23(6):769-76. [Medline].

  14. Shurtleff BT, Barone JG. Urethral prolapse: four quadrant excisional technique. J Pediatr Adolesc Gynecol. Aug 2002;15(4):209-11. [Medline].

  15. Smith GH, Duckett JW. Urethral lesions in infants and children. In: Gillenwater JY, Grayhack JT, Howards SS, Duckett JW, eds. Adult and Pediatric Urology. 3rd ed. Mosby-Year Book; 1996:2431-43.

  16. Valerie E, Gilchrist BF, Frischer J, et al. Diagnosis and treatment of urethral prolapse in children. Urology. Dec 1999;54(6):1082-4. [Medline].

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Further Reading

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Keywords

urethral anomalies, urethral prolapse, lacuna magna, sinus of Guérin, urethral duplication, epispadiac urethral duplication, hypospadiac urethral duplication, Y-type urethral duplication, anterior urethral valves, urethral diverticula, anterior urethral diverticula, megalourethra, scaphoid megalourethra, fusiform megalourethras, urethral diverticulum, urethral polyps, congenital urethral polyps, Cowper duct cysts, urethral prolapse, prune belly syndrome, cloacal malformations, vertebral, anal, cardiac, tracheal, esophageal, renal, limb, VACTERL, posterior urethral valves, hydronephrosis, urinary tract infection, UTI

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Contributor Information and Disclosures

Author

Jyoti Upadhyay, MD, FAAP, Consulting Staff, Children's Surgical Specialty Group, Children's Urology, Children's Hospital of the King's Daughters, Sentara Norfolk Hospital, Sentara Leigh Hospital
Jyoti Upadhyay, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Medical Association, American Urological Association, Endourological Society, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

Coauthor(s)

Carlos A Angel, MD, Associate Professor of Pediatrics, Division of Pediatric Surgery, University of Tennessee School of Medicine; Consulting Staff, East Tennessee Children's Hospital, East Tennessee Pediatric Surgery Group
Carlos A Angel, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, British Association of Paediatric Surgeons, Children's Oncology Group, International Children's Continence Society, International Pediatric Endosurgery Group, New York Academy of Sciences, Society of Critical Care Medicine, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Medical Editor

Bartley G Cilento, Jr, MD, Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School
Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

 
 
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