Introduction

Urethral prolapse¹ occurs when there is eversion of the urethral mucosa.

Epidemiology

This occurs most commonly in premenarchal girls, (particularly those of African descent) and postmenopausal Caucasian women.

Etiology

The etiology is unknown. Lack of estrogen may play a role.

Symptoms and clinical features

The lesions are usually asymptomatic in children but dysuria and local discomfort, or difficulty voiding may occur. Spotting may also occur.

A urethral prolapse resembles a urethral caruncle, but whereas the latter is seen as a dome-shaped lesion, the prolapse is more circumferential, partially or wholly surrounding the urethra. It is bright red in color.

Diagnosis

Diagnosis is clinical. Biopsy should be done if there is concern about possible carcinoma. Biopsy will show normal urethral epithelium and inflammation.

Pathology/Laboratory Findings

The reason to biopsy is to rule out a carcinoma in postmenopausal women.²

Differential diagnosis

Differential diagnoses include hemangioma, polyp, urethral caruncle, and urethral carcinoma.

Treatment/management

For small asymptomatic lesions, no treatment is needed. Localized, topical estrogen therapy may be helpful. Manual reduction of the prolapse may help but the condition may recur.³

1. Edwards L and Lynch PJ. Genital Dermatology Atlas, second edition. Wolters Kluwer Health/Lippincott Williams and Wilkins. 2011. 90-91.
2. Heller DS and Wallach RC. Vulvar Disesase: a clinicopathological approach. Informa Healthcare, 2007. 168.
3. Edwards L and Lynch PJ. Genital Dermatology Atlas, second edition. Wolters Kluwer Health/Lippincott Williams and Wilkins. 2011. 90-91.