Failed Conservative Management in a 6-yearold Girl with Urethral Prolapse: Is Always the Surgery the Solution?

Urethral prolapse (UP) is a rare condition in young female children, with an incidence of 1 in 3000. It commonly presents with vaginal bleeding or dysuria, and is characterized by a circular protrusion of the distal urethra mucosa through the external urethral meatus, forming a round, soft red-purple colored mass. A 6-year-old girl was admitted to our surgical department with symptoms of vaginal bleeding over the last 4 days. Physical examination revealed a doughnut-shaped mass prolapsing from the pudendal labia. Abdominal ultrasound, pelvic magnetic resonance imaging, and blood tests, including hormonal tests, were normal. We initially decided on conservative treatment with topical oestrogen cream and sitz baths. After 12 days, no improvement was observed, and surgical management was undertaken. The surgical approach involved the complete excision of the prolapsed tissue and mucosal to mucosal anastomosis with Vicryl 5/0 sutures. A cystoscopy was previously performed, and the results was normal. Postoperative follow-up over a 6-month period showed no recurrence or urethral stricture. UP in children should always be considered in cases of unexplained vaginal bleeding. Management remains controversial. Surgical excision is recommended for severe cases and in cases that conservative management is uneffective whithin 2-4 weeks.