Urethral prolapse: An important differential diagnosis of bleeding from the vulva in pre‑pubertal African girls
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Abstract
Urethral prolapse is the abnormal protrusion of the urethral mucosa through the external urethral meatus. It is a rarely diagnosed condition as most cases will be misdiagnosed as sexual abuse. If diagnosed, however, medical treatment with follow-up will usually suffice. If this fails, or in the presence of complications, surgical management may be employed. The most common presenting feature is urogenital bleeding. Genital bleeding in a pre-pubertal child is alarming to parents. Their first impression is that of a sexual abuse resulting in the suspicion of all adult males in the surrounding environment. The condition is worsened by a scenario in which the child is either too little to give an account or where she points accusing fingers to some adults. We report a case of bleeding from the vulva from urethral prolapse masquerading as suspected sexual abuse from an unknown adult.
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References
1. Urethral Prolapse. Available from: http://www.emedicine. medscape.com/article/443165‑treatment#showall. [Last accessed on 2015 Sep 11].
2. Anveden‑Hertzberg L, Gauderer MW, Elder JS. Urethral prolapse: An often misdiagnosed cause of urogenital bleeding in girls. Pediatr Emerg Care 1995;11:212‑4.
3. Shavit I, Solt I. Urethral prolapse misdiagnosed as vaginal bleeding in a premenarchal girl. Eur J Pediatr 2008;167:597‑8.
4. Fiogbe MA, Hounnou GM, Koura A, Agossou‑Voyeme KA. Urethral mucosal prolapse in young girls: A report of nine cases in Cotonou. Afr J Paediatr Surg 2011;8:12‑4.
5. Pouya M, Van Cangh PJ, Wese FX, Opsomer RJ, Saleh M. Mucous prolapse of the urethra. Acta Urol Belg 1995;63:23‑9.
6. Urethral Prolapse. Division of Urology, The Children’s Hospital of Philadelphia. Available from: http://www.chop.edu/conditions‑diseases/urethral‑prolapse#.VfL1dn2cUdU. [Last accessed on 2015 Sep 11].
7. Holbrook C, Misra D. Surgical management of urethral prolapse in girls: 13 years’ experience. BJU Int 2012;110:132‑4.
8. Falandry L. Prolapse of the urethra in black girls. Personal experience in 11 cases. Med Trop (Mars) 1994;54:152‑6.
9. ValerieE, GilchristBF, FrischerJ, ScrivenR, KlotzDH, RamenofskyML, et al. Diagnosis and treatment of urethral prolapse in children. Urology
1999;54:1082‑4.
10. Shurtleff BT, Barone JG. Urethral prolapse: Four quadrant excisional technique. J Pediatr Adolesc Gynecol 2002;15:209‑11.
11. Johnson CF. Prolapse of the urethra: Confusion of clinical and anatomic characteristics with sexual abuse. Pediatrics 1991;87:722‑5.
12. Vunda A, Vandertuin L, Gervaix A. Urethral prolapse: An overlooked diagnosis of urogenital bleeding in pre‑menarcheal girls. J Pediatr 2011; 158:682‑3.
13. Kisanga RE, Aboud MM. Urethral mucosa prolapse in young girls. Cent Afr J Med 1996;42:31‑3.
14. Richardson DA, Hajj SN, Herbst AL. Medical treatment of urethral prolapse in children. Obstet Gynecol 1982;59:69‑74.
15. da Silva‑Anoma S, Bertin KD, Ossenou O, Gaudens DA, Yao D, Roux C, et al. Prolapse of the urethral mucosa in young girls from the ivory coast. Ann Urol (Paris) 2001;35:60‑3.
16. Jiménez Parra JD, CebriánLostal JL, Lozano Uruñuela F, Alvarez Bandrés S. Urethral prolapse in postmenopausal women. Actas Urol Esp 2010;34:560‑72.
17. Wong HY, Tsui SY, Mou WC, Lee KH. Blood spotting on underpants: Case report of urethral prolapsed in a pre‑pubertal Chinese girl. J Paediatr Surg 2015;3:192‑3.