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You are seeing a 5 year old girl who presents with dysuria and small amounts of blood in her underwear for 3 days. She has no fever, urinary frequency, abdominal pain, or history of trauma or straddle injury. Her mother noted a swelling at her vaginal introitus and shows it to you. She has a red donut-like mass just above the vaginal introitus where you expect to see her urethra.
Kelly August 21, 2021 - 11:16 am
E) Application of topical estrogen cream + sitz baths + follow-up
The description is classic for urethral prolapse. Pediatric urethral prolapse is most common in pre-pubertal girls, with a predilection for Black girls. Common symptoms include dysuria, hematuria, and vaginal bleeding. The classic donut appearance differentiates urethral prolapse from the less common diagnoses of sarcoma butyroides or prolapsed ureterocele. Treatment includes sitz baths and topical 0.01% estrogen cream twice daily. Usually the prolapse self-resolves within a few weeks, but close follow-up is important, with referral to a pediatric urologist if it is not resolving or there are complications such as excessive pain concerning for necrosis.