URETHRAL PROLAPSE IN GIRLS - A SERIES OF 27 CASES

Urethral prolapse is a benign lesion of the terminal urethra, usually seen in young Negroid girls. Twenty-seven children with urethral prola pse treated at the University Hospital of the West Indies between Janu ary 1982 and December 1991 were prospectively studied; 74% were betwee n the ages of 3 and 7 years. Bloody discharge was the most common symp tom. Vulval bleeding together with a bruised appearance of the urethra resulted in erroneous initial suspicion of sexual abuse in 3 children . Prolapse was graded from I to IV depending on the extent of prolapse and degree of inflammation. Initial therapy in the 25 prepubertal gir ls consisted of sitz baths and topical application of either an antimi crobial ointment (15 girls) or 0.5% oestrogen cream (10), chosen rando mly. Complete resolution of the prolapse occurred in only 4 children, 3 of them from the oestrogen group. Although the oestrogen led to a be tter response, it also caused theliarchy in 2 girls. Three children wh o had only transient improvement and 2 post-pubertal patients had surg ical excision of the prolapse. Post-excision there were no complicatio ns or recurrence of prolapse. Three girls who had improvement with non operative therapy continued to have grade II prolapse even after puber ty. Initial therapy of urethral prolapse in prepubertal girls can be n on-surgical, however, when this fails to achieve resolution surgical e xcision is simple, safe, and curative.