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Urethrocele

Urethra Prolapse

Urethrocele or urethral prolapse is a rare condition characterized by the prolapse of the mucous membrane of the urethra through the external meatus. It can occur in young girls as well as older women and can be diagnosed clinically without radiological procedures.


Presentation

Urethrocele occurs most frequently in African American girls < 10 years of age [1] and postmenopausal Caucasian women. Several etiologies have been postulated for its development such as estrogen deficiency, poor muscle tone or abnormality of muscles in the vicinity of the urethra [2] [3], and treatment of stress urinary incontinence with bulking agents [4]. It has also been reported to occur spontaneously [5] or could be hereditary [6].

Two types of presentations are noticed clinically depending on the age group: prepubertal and postmenopausal. In prepubertal patients, urethrocele is usually asymptomatic and is noticed incidentally. In symptomatic patients, spotting of underclothes and a periurethral mass are the common features with urinary complaints, acute retention of urine [7] and strangulation being rare. Pain in the genital region may be reported if the urethrocele becomes thrombosed.

Postmenopausal patients present with bleeding per vagina and urinary symptoms such as hematuria, dysuria, increased urinary frequency, urinary tract infections and nocturia. Patients may complain of pelvic or genital pain with a feeling something coming out of the vagina with dyspareunia. Symptoms can worsen with coughing or straining. Urethrocele strangulation is more frequently reported amongst postmenopausal women compared to prepubertal patients.

Pharyngitis
  • All MayoClinic.com Topics  Choose most specific and relevant code (need human decision)  Acute pharyngitis instead of URI  See description for more details (inclusions, exclusions) N811 Cystocele Cystocele with urethrocele Prolapse of (anterior) vaginal[wordnik.com]
Decreased Libido
  • Sexual problems, including pain and decreased libido. Constipation. Vaginal discharge or bleeding. Treatment and recovery Once a prolapse has developed, surgery to fix the affected organs is usually the only way to cure it effectively.[mumsnet.com]
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[healthline.com]
Urinary Stress Incontinence
  • Some women find that they have urinary stress incontinence or the inability to empty the bladder completely, which may be an indication of an early cystocele.[incostress1.wordpress.com]
  • This is a urethrocele and the symptom is call urinary stress incontinence (USI).[drjamespurdy.com]
Urethral Disease
  • . , , , , Source MeSH Child Diverticulum Humans Male Scrotum Treatment Outcome Urethra Urethral Diseases Pub Type(s) Case Reports English Abstract Journal Article Language fre PubMed ID 10352818 TY - JOUR T1 - [Congenital urethrocele in children.[unboundmedicine.com]
  • . , , , , Source MeSH Child Diverticulum Humans Male Scrotum Treatment Outcome Urethra Urethral Diseases Pub Type(s) Case Reports English Abstract Journal Article Language fre PubMed ID 10352818 Citation Amrani, A, et al.[unboundmedicine.com]
Dysuria
  • Postmenopausal patients present with bleeding per vagina and urinary symptoms such as hematuria, dysuria, increased urinary frequency, urinary tract infections and nocturia.[symptoma.com]
  • Classically, the presenting symptoms are summarized as the "3Ds" 4 : dysuria: 30-70% post-void dribbling: 10-30% dyspareunia: 10-25% Usually, an array of non-specific genitourinary symptoms predominates 1,4 .: frequency/urgency: 40-100% recurrent urinary[radiopaedia.org]

Workup

Urethrocele is diagnosed after a complete history and a thorough pelvic exam with and without straining or coughing. It can be present concomitantly with a cystocele or uterine prolapse and should be differentiated from inflamed Bartholin and Skene glands. On examination, the urethrocele is seen as a pinkish or reddish ulcerated mucosal mass around the external meatus, protruding [8] through the anterior aspect of the vagina. In prepubertal patients, the mass is located in the middle of the external urethral meatus while in postmenopausal adults, the prolapsed mass protrudes through the meatus. If the urethrocele is thrombosed or strangulated, it may appear bluish in color. Examination of pediatric patients should ideally be performed during voiding or after catheterization of the central opening of the urethra which is visualized in the prolapsed mass. General anesthesia may be required to perform the exam in pediatric patients. Cystourethroscopy is useful to detect the urethrocele in postmenopausal women.

Radiological tests such as a pyelogram and voiding cystourethrogram are usually not required to diagnose the condition. They may be ordered if an underlying malignancy or anatomical abnormality is suspected. Magnetic resonance imaging (MRI) is the preferred modality for evaluating a urethrocele [9].

Histologically, the urethrocele mucosa appears edematous, thrombosed with scanty inflammation.

Treatment

  • The results of this treatment in 41 cases of recurrent urethrocele are given in this paper. The follow-up period for the patients was from 15 to 2 years.[ncbi.nlm.nih.gov]
  • Surgical treatment If nonsurgical treatments aren’t effective or aren’t an option, your doctor may recommend surgery, such as anterior vaginal wall repair , to strengthen the supporting structures.[healthline.com]

Prognosis

  • Las Palmas prognosis for urethrocele surgery is by large degrees positive. Our patients can expect to return to a lifestyle without the disruptions associated with urethra prolapse.[laspalmasobgyn.com]
  • PMID: 7901057 Prognosis Garnier S, Maillet O, Cereda B, Ollivier M, Jeandel C, Broussous S, Lopez C, Paris F, Philibert P, Amouroux C, Jeandel C, Coffy A, Gaspari L, Daures JP, Sultan C, Kalfa N BJU Int 2017 Jun;119(6):942-947.[ncbi.nlm.nih.gov]
  • The prognosis for girls with labial adhesions is excellent.[slideplayer.com]
  • Slide 37 Prognosis The prognosis for girls with labial adhesions is excellent. If left untreated, the condition usually resolves spontaneously at puberty.[dokumen.tips]
  • C (Gd) IV gadolinium can be administered for detection of inflammation or infection it can also aid in the diagnosis of the rare diverticular adenocarcinoma malignancy can be visualized as enhancing soft tissue within the diverticulum Treatment and prognosis[radiopaedia.org]

Etiology

  • Carriage for long time of urethral catheter and urethroplasty are the more frequent etiologies of this affection.[ncbi.nlm.nih.gov]
  • Several etiologies have been postulated for its development such as estrogen deficiency, poor muscle tone or abnormality of muscles in the vicinity of the urethra, and treatment of stress urinary incontinence with bulking agents.[symptoma.com]
  • The chapters are organized by disease and each includes information on etiology, diagnosis, differential diagnosis, the conventional therapy (drug, procedure, etc.), complementary therapy (acupuncture, chiropractic and manipulative therapy, biofeedback[books.google.com]
  • [from NCI ] Etiology Am J Obstet Gynecol 2017 Nov;217(5):598.e1-598.e11. Epub 2017 Jul 8 doi: 10.1016/j.ajog.2017.07.001.[ncbi.nlm.nih.gov]
  • If the etiology for AUR is not found on initial evaluation, patients should be referred to a urologist to evaluate for less common anatomic etiologies (eg, urethral stricture or urethral diverticulum) and/or for possible bladder function testing.[quizlet.com]

Epidemiology

  • It is an epidemiological, observational, multi-center, transversal and comparative study of patients with and without osteoarthritis; carried out by a number of primary care centers in Spain.[bioiberica.com]
  • Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12. CrossRef PubMed Google Scholar 11.[doi.org]
Sex distribution
Age distribution

Prevention

  • • Increased daily intake of fiber and fluid to prevent constipation • Discussing the possibilities and risks of estrogen replacement therapy with your physician Back to Pelvic Organ Prolapse[marinpmc.com]
  • At Las Palmas, we use comprehensive diagnostic tools to locate urethroceles in an effort to prevent them from becoming intensely problematic.[laspalmasobgyn.com]
  • […] ineffable , inflectional , inflexible , injectable , insensible , intensional , intentional , intestinal , lamentable , licensable , millesimal , obsessional , ostensible , parenchymal , perceptible , perceptual , perfectible , polemical , presentable , preventable[rhymezone.com]
  • To avoid getting this far, prevention is the best method. Kegel exercises should be carried out on a regular basis starting in your early 20’s or even in your late teens.[incostress1.wordpress.com]
  • This prevents prolapse from recurring. There are several types of surgery to correct stress urinary incontinence. These surgeries lift the urethra and/or bladder into their normal position.[uwhealth.org]

References

Article

  1. Trotman MDW, Brewster EM. Prolapse of the urethral mucosa in prepubertal West Indian girls. British Journal of Urology. 1993;72 (4):503–505
  2. Lowe FC, Hill GS, Jeffs RD, Brendler CB. Urethral prolapse in children: insights into etiology and management. The Journal of Urology. 1986;135 (1):100–103
  3. Ola B, Arowojolu OA. Urethral prolapse in a West African hospital. International Journal of Gynecology and Obstetrics.1999;66 (2):187–188.
  4. Ghoniem GM, Khater U. Urethral prolapse after durasphere injection. International Urogynecology Journal and Pelvic Floor Dysfunction. 2006;17 (3):297–298.
  5. Yucetas U, Balaban M, Aktas A, Guc B. Spontaneous postmenopausal urethral prolapse: a case report and review of literature. Archivio Italiano di Urologia e Andrologia. 2012;84 (4):214–215.
  6. Mitre A, Nahas W, Gilbert A, et al. Urethral prolapse in girls: familial case. J Urol. 1987 Jan;137(1):115.
  7. 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.
  8. Klein I, Dekel Y, Stein A. Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully. 2014; 2014: Article ID 695471, 2 pages.
  9. 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.

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Last updated: 2017-08-09 17:37