Childhood urethral mucosa prolapse: outcome of surgical treatment

Background: Urethral mucosa prolapse before menarche and so in the child is an uncommon entity that affects the distal urethra and is rarely diagnosed. It is associated with significant morbidity and there is a danger of urethral loss if appropriate treatment is not initiated promptly. We have reviewed our experience managing these children over a ten year period.
Results: All the patients were native African girls with ages 3-9 years and an average age of 5.3 years. The clinical presentation was i. genital bleeding 75%, ii,genital swelling 25% and iii painful micturition in 41% of cases. Two (16%) of the 12 patients, had had some form of female genital mutilation. Of the 9 patients that had urine culture in their preoperative evaluation, 4 (44.5%) of them had their urine culture positive for bacterial growth. Sitz bath was the only form of non surgical treatment offered to 3 (25%) patients. The 12 patients had surgical excision of the prolapsed mucosa; 7 (58%) patients had four quadrant excisional technique, 4 (33%) and 1 (8%) patient(s) had excision without a catheter insitu and excision with a catheter insitu respectively. Post operative urinary retention occurred in one patient. There was no case of recurrence during the 6 months follow-up period.
Conclusion: Though a rare condition, surgical management of premenarcheal urethral mucosa prolapse is associated with good outcome.