Friday, December 12, 2008

Urethral Prolapse

It's not quite the same as pelvic prolapse. Pelvic prolapse is the abnormal descent of female pelvic organs into the vagina, or out the vaginal opening. This would include cystocele for the bladder, rectocele for the rectum, enterocele for the small intestine, vault prolapse for the vaginal apex after hysterctomy, or procidentia for uterine descent. It is an abnormal herniation of these organs due to intra-abdominal pressure pushing down on these organs as a result of poor pelvic floor support.

A urethral prolapse, also known as a urethral caruncle, is the mucosal lining of the urethra that protrudes and is visible at the urethral opening. It is not caused by pelvic floor weakness, rather, in women, it is caused by menopause and the low estrogen staus of the vagina and urethra. The prolpase will appear like a small red pimple on the urethral meatus (opening). It is usually of no significance, but its presence indicates hypo-estrogenization.

Uncommonly, it can bleed or cause blood spotting in the urine or cause pain if it gets large. If large, it can cause deflection of the urinary stream. If it doesn't bother the woman, then nothing has to be done. If the vagina is dry already, consideration can be given to applying local estrogen cream to help the prolapse retract and improve the vaginal health. If the urethral prolapse is spotting blood or painful, estrogen cream should be applied. Only when estrogen cream has not worked or if large and painful does the prolapse need to be removed in the operating room.

A urethral prolapse is NOT a polyp of the urethra. Most polyps of the urethra are benign and can be removed surgically. Tumors of the female urethra are rare entities, but present as polyps and are removed as well.


Anonymous said...

I am 53 years old and have been going through menopause for several years-actually have not had a period for four years but can't recall what the cutoff is for peri- and post-menopause. Regardless, I have never heard of this condition until now, though I've done a fair amount of reading and research. This is my very first hit to indicate my condition and I'll continue looking for more info on it, i.e., how common/unusual is it, will I return to my previous condition (don't want to say "normal" bc maybe this is normal for me now!). Please, if anyone reads this, leave a post.

Matthew E. Karlovsky, M.D. said...

@ Anonymous:

This is a normal age related change with menopause and is usually asymptomatic. It can lead to blood spotting or stream spraying or grow. It should be periodically monitored with a pelvic once a year

Anonymous said...

I believe I have a small urethral prolapse. You really do not see it when I am laying down, but when upright I can see a small protrusion. I have been told that I have microscopic blood in my urine. As I prep myself for a C&S of my urine, wouldn't the tip of the meatus (which is exposed) cause blood to be in my urine? They have done a cysto and a renal ultrasound.
The cysto did not show any abnormalities and the result of the renal ultrasound is pending. I'm just wondering if that would be the logical answer. Please help. Thank you!

Anonymous said...

I am 38 year old female, my urethra has prolapsed and is pertruding out. my urinoligist has blown up my urethra, that failed, it went worse than before, than the urinoligist cut urethra open and stitched to wall that has now failed, i am in alot of pain and the doctor don't know what to do with me anymore, i need a specialist who has seen this before and knows what to do. my doctor does not know anybody. i live in ontario can you please help Lisa Page

Matthew E. Karlovsky, M.D. said...

A urethral prolapse recurrence does not commonly occur. I wonder what is really going on here. You should see a urologist at one of the universities in Canada. A well known urologist is Dr Sender Herschorn (?spelling). See him

Anonymous said...

I am 54 years old and a little over a year into menopause. I was diagnosed with urethral prolapse about 2 yrs. ago and was told the cause was lack of estrogen. I have been using Estrace cream directly on the urethra about twice a week, and it has helped considerably.

As a result of being told I have osteopenia, I am now walking briskly about 2 miles a day and am using some weight machines at the local Y. My GYN didn't think this would be a problem as long as I wasn't lifting too heavily, but I'm concerned. Can exercise make the prolapse worse? Other than the Estrace cream, is there anything else I should be doing?

Thank you for providing some information on this condition, as there's not much out there on it. In fact, I had to go quite the circuitous route to find out this is what was causing micro blood in my urine. Neither the nurse practitioner at my primary care office considered this possibility, and my GYN (a female) didn't either. I wound up enduring a complete hematuria workup (which came out negative) and wasn't told about the prolapse until I sought out a URO-GYN (another female).

Matthew E. Karlovsky, M.D. said...

exercise does not cause a urethral prolapse. Lack of estrogen does. therefore if you continue the Estrace the urethral prolapse is being treated/prevented. It can alo cause microhematuria as you have found out.