Urethral Prolapse Workup

  • Author: Raymond Rackley, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jan 23, 2012
 

Imaging Studies

  • Routine evaluation with intravenous pyelograms and voiding cystourethrograms is unnecessary except in cases in which there is doubt concerning malignancy, prolapsed ectopic ureterocele, or abnormalities of the ureterovesical junction.
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Diagnostic Procedures

  • The diagnosis of urethral prolapse is made by verifying that a central opening is present within the prolapsed tissue and that this opening is the urethral meatus.
    • In children, observation during voiding or catheterization of the central opening is diagnostic.
    • In adults, urethral catheterization or cystourethroscopy verifies the presence of the urethral meatus.
    • Absence of the urethral meatus at the center of the prolapsed mucosa precludes the diagnosis of urethral prolapse.
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Histologic Findings

Urethral prolapse does not have pathognomonic features; however, histological examination reveals ulcerated polypoid tissue composed of fibrovascular stroma with dilated veins and a few organized thrombi. Mucosal edema, vascular thrombosis, and inflammatory cells may also be present.

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Contributor Information and Disclosures
Author

Raymond Rackley, MD  Professor of Surgery, Cleveland Clinic Lerner College of Medicine; Staff Physician, Center for Pelvic Medicine and Pelvic Reconstruction, Glickman Urological Institute, Joint Appointment with Women's Institute Cleveland Clinic Foundation

Raymond Rackley, MD is a member of the following medical societies: American Urological Association

Disclosure: Pfizer, Novartis, Proctor & Gamble, Allergan Honoraria None; Pfizer, Novartis, Proctor & Gamble, Allergan Consulting fee Other

Coauthor(s)

Sandip P Vasavada, MD  Physician, Associate Professor of Surgery, Cleveland Clinic Lerner College of Medicine, Center for Female Urology and Genitourinary Reconstructive Surgery, The Glickman Urological and Kidney Institute; Joint Appointment with Women's Institute, Cleveland Clinic

Sandip P Vasavada, MD is a member of the following medical societies: American Urogynecologic Society, American Urological Association, International Continence Society, Society for Urology and Engineering, and Society of Urodynamics and Female Urology

Disclosure: Pfizer Consulting fee Speaking and teaching; NDI Medical, LLC Ownership interest Review panel membership; AMS Consulting fee Consulting

Farzeen Firoozi, MD  Clinical Fellow, Center for Female Urology and Pelvic Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation

Farzeen Firoozi, MD is a member of the following medical societies: American Medical Association and American Urological Association

Disclosure: Nothing to disclose.

Michael S Ingber, MD  Clinical Fellow, Glickman Urological and Kidney Institute of the Cleveland Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Allen Donald Seftel  MD, Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel is a member of the following medical societies: American Urological Association

Disclosure: lilly Consulting fee Consulting; sanofi-aventis Consulting fee Consulting; auxilium Consulting fee Consulting; solvay Consulting fee Consulting; plethora Grant/research funds clinical trial; endo Consulting fee Consulting; nature publishing journal editor

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark Jeffrey Noble, MD  Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

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  2. Lai HH, Hurtado EA, Appell RA. Large urethral prolapse formation after calcium hydroxylapatite (Coaptite) injection. Int Urogynecol J Pelvic Floor Dysfunct. Sep 2008;19(9):1315-7. [Medline].

  3. Redman JF. Conservative management of urethral prolapse in female children. Urology. May 1982;19(5):505-6. [Medline].

  4. Wright M. Urethral prolapse in children--alternative management. S Afr Med J. Oct 17 1987;72(8):551-2. [Medline].

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

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  9. 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].

  10. Desai SR, Cohen RC. Urethral prolapse in a premenarchal girl: case report and literature review. Aust N Z J Surg. Sep 1997;67(9):660-2. [Medline].

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  12. Falandry L. [Urethral prolapse in young black girls. Report of 12 cases]. Prog Urol. Jun 1996;6(3):392-7. [Medline].

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  15. Harris RL, Cundiff GW, Coates KW, et al. Urethral prolapse after collagen injection. Am J Obstet Gynecol. Mar 1998;178(3):614-5. [Medline].

  16. Kisanga RE, Aboud MM. Urethral mucosa prolapse in young girls. Cent Afr J Med. Jan 1996;42(1):31-3. [Medline].

  17. Kleinjan JH, Vos P. Strangulated urethral prolapse. Urology. Apr 1996;47(4):599-601. [Medline].

  18. Mianne D, Beatrix O, Faure JM, et al. [Strangulated urethral prolapse in a young woman: a rare urological emergency]. Prog Urol. Dec 1994;4(6):1022-6. [Medline].

  19. Nishi M, Toyoda N. [Reposition of the urethra in urethral prolapse]. Shujutsu. Feb 1972;26(2):126-30. [Medline].

  20. 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].

  21. Sen I, Onaran M, Tokgoz H, Tan MO, Biri H, Bozkirli I. Prolapse of a simple ureterocele presenting as a vulval mass in a woman. Int J Urol. Apr 2006;13(4):447-8. [Medline].

  22. Thosaka A, Yamazaki A, Hirokawa M, et al. [Two cases of urethral leiomyoma]. Hinyokika Kiyo. Nov 1988;34(11):2041-6. [Medline].

  23. Turner RW. Urethral prolapse in female children. Urology. Nov 1973;2(5):530-3. [Medline].

 
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Pediatric urethral prolapse. Note the complete circular eversion of the distal urethral mucosa.
Urethral prolapse. Intraoperatively, the prolapsed mucosa is excised in quadrants, and the 2 layers of smooth muscle are apposed together.
Urethral prolapse. Postoperative depiction of a normal-appearing urethra after surgical excision.
 
 
 
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