Urethral Prolapse: Four Quadrant Excisional Technique

Background: Urethral prolapse is a condition that occurs when urethra mucosa evaginates beyond the urethra meatus, resulting in vascular congestion and edema of the prolapsed tissue. Young females with this clinical entity often present with peri-vaginal bleeding and swelling. Urethral prolapse can be diagnosed by its typical clinical appearance and should not be confused with other causes of peri-vaginal bleeding, most importantly, sexual abuse. Case: We retrospectively evaluated the charts of three girls, ages 4, 6, and 8, who presented complaining of vaginal blood spotting. On examination, a ring of congested, edematous tissue was seen prolapsing through the urethral meatus in each patient. All patients did not respond to medical management and required surgical removal of the tissue. We herein discuss and evaluate their management and our four quadrant excisional technique. Conclusion: Urethral prolapse can be definitively diagnosed without laboratory or radiographic evaluation by demonstrating that the edematous tissue surrounds the meatus circumferentially. Initial treatment consists of parental reassurance, observation, and warm soaks. If the prolapse does not demonstrate improvement, excision of the prolapsing tissue may be necessary. We believe that our surgical technique facilitates removal of the prolapsed tissue and anastomosis of the residual urethral mucosa.