Pediatric emergency medicine trisk 2166 2166

the bladder through the mass can be performed to demonstrate the anatomic
relationships safely and rapidly. Urinalysis may show red blood cells and urine
cultures are routinely sterile, though these tests may not be clinically indicated if
the child otherwise looks well. Urethral polyps, prolapsed ureterocele, sarcoma
botryoides, and urethral carcinoma may be included in the differential diagnosis,
but they are rare in children and lack the characteristically annular appearance of
a urethral prolapse.

FIGURE 92.6 A : Urethral prolapse in a 6-year-old girl with “vaginal” bleeding. The vaginal
orifice cannot be seen. B : The smooth doughnut shape and central lumen are characteristic
features of a urethral prolapse, which if large or swollen, often conceals the vagina below it.

Management
For the symptomatic patient with a small segment of prolapsed mucosa that is not
necrotic, warm moist compresses or sitz baths, combined with a 2-week course of
topical estrogen cream, may be prescribed. Most patients treated in this way have
improved within 10 to 14 days and remained normal thereafter, thus avoiding
surgery. Patients with dark-red or necrotic mucosa should be treated surgically
within several days by reduction of the prolapse and/or excision of necrotic
tissue. After the diagnosis is confirmed by cystoscopy, the prolapse is excised and
the cut edges are sutured together. It is also important for the practitioner to
address any precipitant related to the prolapse such as chronic constipation or
other Valsalva-related intra-abdominal strain.
Manual separation of adhesions should be avoided.

Contraceptive Devices
Background