Urethral prolapse is the circumferential eversion of the epithelium of the distal urethra [1]. A relatively rare lesion, its incidence is estimated at 1/3000 and is observed mainly in black girls [2][3]. The etiopathogenesis is poorly understood but some factors have been incriminated including trauma, urinary and vaginal infections, redundancy of the urethral mucosa, episodic increase in intra-abdominal pressure, estrogen deficiency and poor socio-economic conditions [4]. The diagnosis is clinical, the treatment is medical-surgical [1].

The lack of previous data motivated the launch of this study, the objectives of which were to describe the diagnostic and therapeutic aspects of urethral prolapse in girls.

This is a retrospective and descriptive study of urethral mucosal prolapse in young girls recorded from the hospitalization records of the urology department of the Sino-Guinean Friendship Hospital in Conakry. Patients were randomly selected. Outcome assessment was based on the occurrence of recurrences and urinary incontinence. The mean follow-up period was 24 months. The parameters studied were: age, clinical and histological results, therapeutic data and patient evolution.

Urethral prolapse is a rare and benign pathology, observed mainly in black girls. Its frequency, variable according to sources, is estimated between 1 and 7.5 cases per year in Africa [5][6]. Kouassi et al. reported an incidence of 4.2 cases per year [7].

This rate is higher than that of our study which revealed an incidence of 2.2 cases per year. However, this result is comparable to that of Amadou et al. who observed 2 cases per year [4].

The average age of onset varies between 4.02 and 7 years [4]. Ludovic Falandry found in his study an average age of 5.2 years [8], while Sanda et al. reported a mean age of 6 ± 3.3 years [1].

For our part, we recorded an average age of 6.7 years. These different ages confirm that urethral prolapse is a pathology that mainly affects young girls who have not yet reached puberty, although cases have also been observed in older women [4].

The frequent involvement of black girls has been reported in several series, without any precise explanation being provided. The etiopathogenesis of urethral prolapse remains uncertain. Estrogen deficiency remains the main hypothesis, thus explaining the higher incidence of urethral prolapse in prepubertal girls and postmenopausal women. Other factors, such as trauma, use of urethral catheters and urinary tract infections, have also been incriminated [7]. Although considered to occur only in black girls, urethral prolapse also affects white girls: Fernandes ET etal. [9] report 14 cases in a series of 23 patients. Other studies reported from Russia, Poland and Korea confirm this observation [1]. Urethral prolapse, however, remains a pathology mainly observed in girls from disadvantaged socioeconomic backgrounds [1].

The diagnosis is primarily clinical. The diagnostic challenge is to differentiate it from condylomas in girls [4]. The circumstances of discovery vary, ranging from genital bleeding (which worries those around you) to pain. However, the typical clinical presentation remains that of a raspberry-shaped swelling, of variable volume, rounded, bleeding and often painful, located in the subclitoral position [4] (Figure 2). The most common accompanying signs are vaginal bleeding. This genital bleeding is most often a source of concern for parents because it is confused with sexual abuse [6][10].

Figure2. Preoperative urethral mucosal prolapse in girls.

In our study, vaginal bleeding was observed in 63.63% of our patients.

These bleedings would result from vascular congestion and edema of the prolapsed tissue surrounding the urethral meatus [11].

Urethral prolapse may be complicated by strangulation. When the urethra is strangulated, it becomes black, cyanotic, edematous, friable, and bleeding [12].

Several therapeutic strategies have been proposed, ranging from conservative options [13] towards more radical approaches [1][5][6] Medical treatment combines sitz baths, antibiotics and anti-inflammatories [1][14].

This medical treatment requires long-term follow-up, as recurrences have been reported up to 2 years after treatment [15]. Due to the risk of recurrence after medical treatment, several authors favor surgical treatment as first-line treatment. [7].

Surgical treatment, on the other hand, consists of excising the prolapsed mucosa [1][2]. We chose surgery because of the risk of recurrence or partial reduction. The surgical technique adopted consisted of excision of the prolapsed mucosa followed by muco-mucosal suture, as described by the majority of authors [1][2][14].

The main complication reported in the literature after surgical treatment is acute urinary retention [7].

However, in our study, we did not observe any complications after surgical excision of the prolapse. Urethral prolapse in girls is a pathology with a favorable prognosis, with satisfactory aesthetic results [1].

The results of surgical treatment are clinically and aesthetically satisfactory in all patients. All girls were successfully cured, without any complications or recurrence.

Urethral prolapse is a benign pathology, but it can be complicated by strangulation, observed mainly in black girls. Its diagnosis is essentially clinical. Surgical treatment, consisting of a complete excision of the prolapsed part, ensures excellent results.

All data is included in the article’s content.

The hospital consented to the use of data from patients who were consulted in the department. This study was approved by the hospital ethics committee and the principles of the Declaration of Helsinki were followed.