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Urethral Prolapse Workup

  • Author: Bradley C Gill, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Mar 31, 2015
 

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. Magnetic resonance imaging has been used in the evaluation of urethral prolapse and other urethral lesions.[2]

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Diagnostic Procedures

See the list below:

  • 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

Bradley C Gill, MD, MS Resident Physician, Department of Urology, Glickman Urological and Kidney Institute; Clinical Instructor of Surgery, Cleveland Clinic Lerner College of Medicine, Education Institute; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic

Bradley C Gill, MD, MS is a member of the following medical societies: American College of Surgeons, American Urological Association, Societe Internationale d'Urologie (International Society of Urology)

Disclosure: Nothing to disclose.

Coauthor(s)

Raymond R Rackley, MD Professor of Surgery, Cleveland Clinic Lerner College of Medicine; Staff Physician, Center for Neurourology, Female Pelvic Health and Female Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic, Beachwood Family Health Center, and Willoughby Hills Family Health Center; Director, The Urothelial Biology Laboratory, Lerner Research Institute, Cleveland Clinic

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

Disclosure: Nothing to disclose.

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 Urological Association, Engineering and Urology Society, American Urogynecologic Society, International Continence Society, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Allergan and Axonics<br/>Received ownership interest from NDI Medical, LLC for review panel membership; Received consulting fee from allergan for speaking and teaching; Received consulting fee from medtronic for speaking and teaching; Received consulting fee from boston scientific for 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, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, SWOG

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, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

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

Disclosure: Received consulting fee from lilly for consulting; Received consulting fee from abbott for consulting; Received consulting fee from auxilium for consulting; Received consulting fee from actient for consulting; Received honoraria from journal of urology for board membership; Received consulting fee from endo for consulting.

Acknowledgements

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

Disclosure: Nothing to disclose.

References
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  2. Surabhi VR, Menias CO, George V, Siegel CL, Prasad SR. Magnetic resonance imaging of female urethral and periurethral disorders. Radiol Clin North Am. 2013 Nov. 51(6):941-53. [Medline].

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

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

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

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

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

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  14. Fletcher SG, Lemack GE. Benign masses of the female periurethral tissues and anterior vaginal wall. Curr Urol Rep. 2008 Sep. 9(5):389-96. [Medline].

  15. Goh JT, Krause HG, ALIA. Postpartum urethral prolapse. Aust N Z J Obstet Gynaecol. 1998 Nov. 38(4):477-8. [Medline].

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

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

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

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

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

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

  22. 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. 2006 Apr. 13(4):447-8. [Medline].

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

  24. Turner RW. Urethral prolapse in female children. Urology. 1973 Nov. 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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