Prolapse of the urethral mucosa in a prepubertal girl
An eight year old girl presented to the Paediatric outpatient department with history of bleeding from the external genitalia which was noticed by her mother as blood stains on her pants. She also had history of dysuria and increased frequency of micturition for the past 5 days. Patient was referred to the Department of Obstetrics and gynecology with provisional diagnosis of urinary tract infection and/ or sexual abuse.

History was not suggestive of any possibility of sexual abuse. She was feeling uncomfortable due to burning sensation in the genital region. On examination, the girl was thin built and there was no pallor. Examination of external genitalia revealed no active bleeding from introitus and perineum appeared normal.

Gentle separation of the labia revealed a 2*2 cm reddish mass, but we could not proceed further with examination as the girl was highly uncooperative due to pain. A provisional diagnosis of interlabial mass probably vaginal tumor was made and authors planned for examination under anesthesia. Pelvic ultrasound and laboratory investigations were normal.

Examination under anesthesia revealed a normal introitus and vagina mucosa. There was a well circumscribed, erythematous, doughnut shaped mass at the urethral meatus. An infant feeding tube was passed through the center of mass which drained clear urine, confirming that the mass was the prolapsed erythematous urethral mucosa. She was diagnosed to have urethral mucosal prolapse.

The girl was prescribed antiinflammatory drugs along with Sitzbath for three days followed by daily local application of estrogen cream. The girl was followed up after 7 days and she was comfortable with no complaints. Local examination revealed that the prolapsed urethral mucosa had reduced considerably. The girl was followed up regularly and no recurrence was noticed during a period of follow up for 3 years.

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