Presentation
AIM: Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse [ncbi.nlm.nih.gov]
Entire Body System
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Malnutrition
Predisposing factors In all, 29 girls had varying degrees of malnutrition, nine were treated for UTIs, 17 had different degrees of cough (amongst them three were diagnosed with bronchial asthma), five were diagnosed with vulvitis, seven had a history [ncbi.nlm.nih.gov]
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Mucosal Edema
Mucosal edema, vascular thrombosis, and inflammatory cells may also be present. Strangulated urethral prolapse appears to be more common in the adult population than in the pediatric population. [emedicine.medscape.com]
Gastrointestinal
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Tenesmus
The menopausal group seeks medical attention primary because of the severity of urinary symptoms, ie, nocturia, urgency, tenesmus, dysuria, and frequency. [ncbi.nlm.nih.gov]
Medical attention is sought mainly by the post-menopausal group because of the severity of urinary symptoms such as nocturia, frequency, dysuria, urgency and tenesmus. [14] The diagnosis of urethral mucosal prolapse is clinical. [phmj.org]
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Lower Abdominal Pain
RESULTS: Urethral prolapse associated with uterovaginal prolapse, lower abdominal pain and dysuria in a 48-year old grand multiparous (para 8 0) farmer who is still observing her monthly menstrual cycle was seen. [ncbi.nlm.nih.gov]
Cardiovascular
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Thrombosis
Children may report genital pain if the prolapsed mucosa becomes very large or if thrombosis and necrosis have developed. [emedicine.medscape.com]
Surgery, though rarely performed among pre-pubertal girls, is the treatment of choice if medical therapy fails to reduce the prolapse and in severe cases such as those with significant bleeding, thrombosis or gangrenous changes. [phmj.org]
Skin
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Excoriation
There was no bleeding on contact, no bleeding per vagina, hymen was intact and there was no lacerations or excoriations. [phmj.org]
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Flushing
To prevent obstruction from the ligature: a reasonably large catheter size should be used and the patency of catheter lumen can be immediately tested by freely flushing normal saline solution through the lumen with a 60cc syringe without any noticeable [numonthly.com]
Musculoskeletal
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Muscle Weakness
Genetic muscle weakness Some people are born with weak pelvic floor muscles. This makes prolapse more likely in people who are younger or haven’t been pregnant. [healthline.com]
Eyes
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Prolapse
OBJECTIVES: To review published reports on urethral prolapse in the pediatric population, with a focus on diagnosis and management, and to do a retrospective review of 20 cases of urethral prolapse at an urban hospital. [ncbi.nlm.nih.gov]
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Retinal Hemorrhage
Bagley Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer Retraction: Retinal Hemorrhage from Blunt Ocular Trauma. N Engl J Med 2019;381:2252. J. Jinagal et al. [nejm.org]
Urogenital
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Vaginal Bleeding
Vaginal bleeding in a prepubertal child is always treated as an alarming symptom both by parents and professionals. [ncbi.nlm.nih.gov]
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Urogenital Bleeding
Twenty children presented with urogenital bleeding. Operative correction was employed as initial treatment in 16 girls, with one recurrence. The remaining eight children were treated nonoperatively. [ncbi.nlm.nih.gov]
The most common presenting feature is urogenital bleeding. Genital bleeding in a pre-pubertal child is alarming to parents. [phmj.org]
Google Scholar 2 : Urethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls. Pediatr Emerg Care 1995 ; 11 : 212. Google Scholar 3 : Reduction of paraphimosis with hyaluronidase. Urology 1996 ; 48 : 464. [auajournals.org]
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Vulvar Irritation
As the prolapse becomes more severe, symptoms may include: vaginal or vulvar irritation a feeling of fullness or pressure in the pelvic and vaginal area aching discomfort in the pelvic area urinary problems, such as stress incontinence, being unable to [healthline.com]
Workup
The clinical picture and workup are described and compared with a review of the international literature on the issue. Copyright 2011 Elsevier Ireland Ltd. All rights reserved. [ncbi.nlm.nih.gov]
Microbiology
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Staphylococcus Aureus
The microscopic examination of urine revealed urinary infection in four patients, showing Escherichia More Details coli in three cases and Staphylococcus aureus in one. [afrjpaedsurg.org]
Treatment
Treatment outcome was evaluated in 59 cases (surgical treatment, n 28; non-surgical treatment, n 31) during a median follow-up period of 10 months. [ncbi.nlm.nih.gov]
Prognosis
[…] stenosis Urinary incontinence (extremely rare) Acute urinary retention Vaginal bleeding Recurrence of prolapse Bleeding from the suture line (early complication) Meatal stricture (delayed complication of surgery) Late recurrences (uncommon) Outcome and Prognosis [emedicine.medscape.com]
Etiology
We report a 4 year old female with urethral prolapse and discuss the etiology and the treatments in children documented in the literature. [ncbi.nlm.nih.gov]
Lowe F, Hill G, Jeffs R and Brendler C (2018) Urethral Prolapse in Children: Insights Into Etiology and Management Journal of Urology, VOL. 135, NO. 1, (100-103), Online publication date: 1-Jan-1986. [auajournals.org]
The proposed etiologies, differential diagnoses, management, and treatment are presented. Prolapse of the urethra should be considered in the differential diagnosis of girls with minimal bleeding per vaginam. Received April 19, 1973. [pediatrics.aappublications.org]
Pathophysiology
Information regarding the treatment and pathophysiology of this clinical entity in postmenopausal women is sparse in the published literature. [ncbi.nlm.nih.gov]
faecal incontinence, benign bladder conditions and urogenital prolapse Demonstrate an understanding of the anatomy, pathophysiology Patterns of Benign Gynaecology Care report 2015-16 procedures including hysterectomy, mid- urethral mesh tape for [rcog.org.uk]
Prevention
To prevent infection, prophylactic antibiotics coverage and a shorter period of catheterization should take place. Figure 1. Urethral Prolapse Figure 2. [numonthly.com]
Oversewing the mucosal edge restores coaptation of the longitudinal and circular-oblique muscle layers to prevent any future recurrence. [emedicine.medscape.com]
Multimedia Selected Multimedia View all multimedia Audio Clinical Practice Audio Interviews Audio Summaries Image Challenge Images in Clinical Medicine Interactive Medical Cases Quick Takes Videos in Clinical Medicine Visual Abstracts View all multimedia Preventing [nejm.org]
Level of prolapse Management and treatment Prevention and mild cases of prolapse Lifestyle changes and preventive measures such as pelvic floor exercises Moderate cases Lifestyle changes Sessions with a pelvic floor physiotherapist to learn the best exercise [jeanhailes.org.au]
This may aid accurate and early diagnosis and thus prevent anxiety and unnecessary parental fright or family tension. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1. Urethral Prolapse. [phmj.org]