Urethral Caruncle Presented as Premature Menarche in a 4-Yea
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Urethral caruncle (UC) is a benign fleshy outgrowth at the urethral meatus. It occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. Few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine.

A 4-year-old girl was brought to the paediatric clinic by her mother with a history of significant bleeding per vagina for 4 days duration. She was a healthy girl with no significant past medical history and was not on any regular drug treatment. Mother brought this girl as she had concerns regarding “how her small girl is going to cope with bleeding per vagina monthly at this young age?” There was no history suggestive of exposure to any sexual abuse or trauma to genitals. There was no history of any urinary symptoms.

On examination, she was not pale. She did not have any secondary sexual characteristics to suggest true premature menarche. Her pulse rate was 88 beats per minute, and her blood pressure was 80/50?mmHg. Her abdominal examination was unremarkable. Examination of the genitalia revealed blood stained vulva with normal female external genitalia. Her urethral meatus was slightly prominent and erythematous. Her full blood count was normal with a haemoglobin of 11.2?g/dl. Except 15–20?red cells/HPF in her urine analysis rest of the investigations were normal including renal functions.

She was referred to the gynaecologist and was examined under general anaesthesia (EUA). It revealed prominent mucosa at the urethral meatus with continuous oozing of blood. During EUA, the gynaecologist suspected the possibility of urethral caruncle or hyperplastic urethral meatus. This prominent mucosal area was excised and sent for histology. Her postoperative period was uneventful and was discharged home on prophylactic antibiotics.

She was seen in the gynaecology clinic after a week. She was completely well, and there was no recurrence of bleeding per vagina. The biopsy histology confirmed the diagnosis of urethral caruncle.

Urethral caruncle is a very rare condition found in prepubertal girls throughout the world. Various forms of treatment have been reported in the literature. But conservative therapy with topical steroid therapy is the core treatment.

Source: https://www.hindawi.com/journals/cripe/2018/3486032/
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