Urethral Prolapse: Contemporary Report on a Modified Ligation Over a Urethral Catheter Treatment Approach

Abstract

BackgroundMost contemporary series on urethral prolapse report either on the use of excisional or conservative treatment approaches.ObjectivesTo introduce a modified ligation over a Foley catheter treatment method for urethral prolapse that addresses most of the previously reported complications.Patients and MethodsFive consecutive patients with urethral prolapse treated between 2003 and 2011, all using the ligation method on an outpatient basis were studied prospectively. Maintaining the inflated balloon of the Foley catheter with timed removal of the catheters among other modifications to the original technique is further described in the article. The main outcome measures were to evaluate for recurrence, post-operative appearance of the urethral orifice and satisfaction of parents. Secondarily the actions of the parents of the patients and those of the receiving physicians were also recorded.ResultsThe mean age of the patients was 6 years old (ranging from 3 to 8 years). All parents suspected sexual molestation and in two cases, the suspected perpetrators were verbally threatened of dire consequences of their actions if proven. None of the receiving medical personnel were aware of this condition. Maximum length of catheterization was for 4 days. The post treatment urethral openings appeared normal and there were no complications.ConclusionsThe ligation method with attention to the modifications described further in the article is a simple, safe and cost effective option for the management of urethral prolapse.Maintaining the inflated balloon of the Foley catheter with timed catheter removal especially adds predictability to this technique.

Spontaneous Postmenopausal Urethral Prolapse Treated Surgically and Successfully

“…According to the literature, surgical excision still remains the most definitive therapy. There are several surgical approaches described, especially among children, like tying the prolapsed tissue on a catheter [ 9 ]. The most frequent complications described are urethral stricture and postoperative urinary retention [ 1 ].…”

Prolapso uretral en una niña con sangrado urogenital

“…4,7 El tratamiento quirúrgico se lleva a cabo con la técnica de Kelly-Burnam modificada, en la que se extirpa la mucosa prolapsada, y la unión mucocutánea se vuelve a aproximar con suturas absorbibles. 5,[7][8][9] La primera línea de tratamiento es médica; sin embargo, si la terapia médica no reduce el prolapso, entonces, la cirugía es el tratamiento de elección. 7,8 El manejo médico no siempre es un tratamiento eficaz para corregir el prolapso y puede tener una tasa de recurrencia del 67 %; 2 la cirugía tiene una tasa de curación más alta y alivia los síntomas rápidamente.…”

“…Las complicaciones que pueden surgir de la escisión quirúrgica incluyen estenosis uretral (el 5,2 %), sangrado (el 2 %) y recurrencia del prolapso (el 2 %). 2,9 Las masas que se pueden encontrar a nivel interlabial en una niña representan un amplio espectro de lesiones heterogéneas y, a menudo, existe confusión en su diagnóstico, manejo y pronóstico. Realizar un examen pélvico adecuado de una niña preadolescente que presenta sangrado vulvovaginal es crucial para formar un diagnóstico preciso y descartar, entre otras causas, el abuso sexual.…”

Diagnosis and management of a urethral prolapse in a 6-year-old girl: a case report

“…Urethral prolapse remains almost unrecognized due to its low Incidence of about 1/5000 children [ 2 ]. It has been reported in several countries in the world and in Africa [ 2 , 3 ]. Unfortunately, to our knowledge, in the Democratic Republic of Congo (DRC), no case has been reported in the literature so far.…”