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.
Urethrocele occurs most frequently in African American girls < 10 years of age  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  , and treatment of stress urinary incontinence with bulking agents . It has also been reported to occur spontaneously  or could be hereditary .
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  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.
Entire Body System
- 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]
- Severe Pain
Patients with strangulated urethral prolapse may report suprapubic tenderness and severe pain during urination. Urethral prolapse is often associated with urinary tract infection. [emedicine.medscape.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]
Urinary stress incontinence - This is a common symptom of a cystocele. Pain that increases during long periods of standing - This may be indicative of an enterocele, vaginal vault prolapse, or prolapsed uterus. [pelvictoner.co.uk]
Urinary stress incontinence — This is a common symptom of a cystocele. Pain that increases during long periods of standing — This may be indicative of an enterocele, vaginal vault prolapse, or a prolapsed uterus. [nyurological.com]
This is a urethrocele and the symptom is call urinary stress incontinence (USI). [drjamespurdy.com]
Affected women may report dysuria, urinary frequency or urgency, and nocturia. Either microscopic or gross hematuria may be present. [emedicine.medscape.com]
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]
Although the baby was started on prophylactic antibiotics (amoxicillin) since birth, on the 16th post-natal day, she was admitted to the emergency due to dysuria noticed by her mother. [medcraveonline.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 to [healthline.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]
disease Urinary tract disease Keyword (es) Diagnóstico Divertículo Estudio caso Hombre Tratamiento Uretra Aparato urinario patología Uretra patología Vía urinaria patología Classification Pascal 002 Biological and medical sciences / 002B Medical sciences [pascal-francis.inist.fr]
- Overflow Incontinence
When either of these disorders is severe, urinary retention and overflow incontinence can occur. When sacral nerves are damaged, urge incontinence may also develop. Enteroceles may cause lower back pain. [msdmanuals.com]
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  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 .
- Trotman MDW, Brewster EM. Prolapse of the urethral mucosa in prepubertal West Indian girls. British Journal of Urology. 1993;72 (4):503–505
- 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
- Ola B, Arowojolu OA. Urethral prolapse in a West African hospital. International Journal of Gynecology and Obstetrics.1999;66 (2):187–188.
- Ghoniem GM, Khater U. Urethral prolapse after durasphere injection. International Urogynecology Journal and Pelvic Floor Dysfunction. 2006;17 (3):297–298.
- 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.
- Mitre A, Nahas W, Gilbert A, et al. Urethral prolapse in girls: familial case. J Urol. 1987 Jan;137(1):115.
- 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.
- Klein I, Dekel Y, Stein A. Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully. 2014; 2014: Article ID 695471, 2 pages.
- 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.