Prepubertal Urethral Mucosal Prolapse Presenting as Vaginal Bleeding: A Case Report Emphasising Awareness and Early Diagnosis
Felix Chikaike C. Wekere *
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria and Department of Community Medicine, Rivers State University, College of Medical Sciences, Port Harcourt, Rivers State, Nigeria.
Joseph N. Kwosah
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Mkpe Abbey
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Uduak S. Ocheche
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria and Department of Obstetrics and Gynaecology, PAMO University of Medical Science, Port Harcourt, Rivers State, Nigeria.
Sokipirim E. Ikiroma
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Ngeri Bapakaye
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Faithwin Horsfall
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Kingdom T. Okah
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
Bruce I
Department of Community Medicine, Rivers State University, College of Medical Sciences, Port Harcourt, Rivers State, Nigeria.
Paamia C. Nuka
Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Urethral mucosal prolapse is a rare benign condition that is often misdiagnosed by clinicians and associated with fear of sexual assault by parents. It occurs in both children and postmenopausal women. The aetiology is unknown, but several theories have been proposed, including genetic factors and intrinsic urethral abnormalities such as increased urethral mobility and poor attachment between the inner longitudinal and outer circular smooth muscle layers of the urethra. The condition may be asymptomatic; however, the most common presentation is vaginal bleeding associated with a periurethral mass. This chapter reports a case of urethral mucosal prolapse in a 6-year-old pupil who presented with vaginal bleeding, for which the parents thought she was sexually assaulted in school; to buttress the need for sensitisation on urethral mucosal prolapse in schools and during community outreaches. Vaginal examination revealed a well-circumscribed doughnut-shaped fleshy mass at the external urethral meatus, for which a diagnosis of urethral mucosal prolapse was made. Although surgery is indicated in some cases, she was managed medically with topical oestrogen cream, and the symptoms resolved. Prepubertal urethral mucosal prolapse is a benign condition and often misdiagnosed; early diagnosis and management will allay parental fears and prevent sequelae. There is a need to create awareness of this condition in schools, particularly through school health programmes, so that teachers and students can recognise it. Community sensitisation by healthcare professionals, including during parent–teacher meetings, is also important. Increasing awareness among the public will improve early recognition and management of this condition.
Keywords: Urethral mucosal prolapse, benign urethral condition, vaginal bleeding, prepubertal girls, misdiagnosis