Pediatric emergency medicine trisk 2165 2165

The peak age for urethral prolapse in prepubertal children is 5 to 8
years.
The majority of children with urethral prolapse present with vaginal
bleeding.
A doughnut-shaped protrusion from the vulva is found in urethral
prolapse.
Prompt attention is needed to correct the prolapse to avoid tissue
necrosis.
Urethral prolapse is the protrusion of the distal urethral mucosa outward
through its meatus, with a cleavage plane between the longitudinal and circularoblique smooth-muscle layers of the urethra. Most prolapses happen
spontaneously, but some episodes are noted to have occurred following a sudden
or recurrent increase in intra-abdominal pressure (coughing, straining with
constipation, lifting heavy objects). The prolapsed segment is constricted at the
meatus and venous blood flow is impaired, so the involved tissue becomes
swollen, edematous, and dark red or purplish. If the urethral prolapse is not
corrected, the tissue can become thrombosed and necrotic.
About half of affected females are prepubertal children, while the majority of
the remainder are postmenopausal women. Most urethral prolapses during
childhood occur between the ages of 2 and 10 years, with the peak at 5 to 8 years
of age. The majority of prepubertal children with urethral prolapse are African
Americans.

Clinical Manifestations
Vaginal bleeding or spotting is the chief complaint of 90% of children with
significant urethral prolapses. The bleeding is painless, occasionally
misinterpreted as hematuria or menstruation, and is sometimes accompanied by
urinary frequency or dysuria. On examination of the child’s perineum, a red or
purplish, soft, doughnut-shaped mass is seen ( Fig. 92.6 ). Most prolapses are not
tender and measure 1 to 2 cm in diameter. By retracting the labia majora
posterolaterally, the examiner can often demonstrate that the mass is separate
from and anterior to the vaginal introitus; this process may be difficult if the

prolapse is large. A small central dimple in the mass indicates the urethral lumen,
though the dimple can be missed if lighting is inadequate, bleeding is active, or
mucosal edema is significant. In most cases, the appearance of the prolapse is
diagnostic. However, if the diagnosis is in doubt, sterile straight catheterization of