What are Benign (Not Cancerous) Uretheral Lesions in Girls?

Female Urinary System
Female Urinary System
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Benign lesions in the urinary tracts of young girls are rare. But when they happen, they can cause problems.

What Happens under Normal Conditions?

The urethra is a tube-like organ that carries urine from the bladder out of the body. In females, the urethra is short. It runs from the bladder to just in front of the vagina and opens outside the body. Normal urine flow is painless and can be controlled. The stream is strong and the urine is clear with no visible blood.

 A lesion is a damaged part of an organ or tissue. The defect keeps the organ from working the way it should.



What are Some Types of Benign Urethral Lesions in Girls?

Lesions can be caused by an accident, infection, or the way the organ grows. Some types of lesions are:

Urethral Polyps

A urethral polyp is a rare, irregular growth that most often appears at birth. This polyp is often made up of fibrous tissue. It may also include some smooth muscle, small cysts, or nerve tissue, all covered with a thin protective layer of tissue. 

Paraurethral Cyst

Paraurethral cysts, also known as Skene's glands, are found in the wall of the vagina near the urethra. In a newborn, Skene's duct can become blocked by a large cyst filled with hormone secretions. Sometimes the cyst may close off the urethral opening.

A paraurethral cyst appears as a glistening, tense, and bulging yellowish-white mass that narrows the urethral outlet.

Urethral Caruncle

Urethral caruncles are polypoid ("stalk-like") masses hanging from part of the urethral outlet. Urethral caruncles are rare in children. The main sign of this problem is a thin, reddish membrane sticking out from the urethral outlet.

Urethral Prolapse

Urethral prolapse is a rare problem of the female urethra. It's much more bothersome than other benign lesions. The urethra's membrane and the spongy tissue below poke out of the urethral outlet. It's thought to be caused by the muscle not joining well to the skin layers of the urethra. This problem is found more often in pre-pubescent African-American girls 5 to 8 years old. Fewer than 1 in 10 cases occur in Caucasian girls.

Urethral prolapse is most often found by physical exam. Your urologist may find a doughnut-shaped mass around the opening of the urethra. Your daughter's urologist might order a pelvic ultrasound to help diagnose the problem. Ultrasound uses sound waves bouncing off organs to show what's inside your body.

The urologist may watch the urine stream flow through the prolapsed urethra when your daughter pees. In more than 1 out of 5 cases, urethral prolapse is misdiagnosed as vaginal bleeding.

Risk factors for this problem include:

Though not likely, chronic cough, asthma, and trauma to the area may also raise the risk.



What are the Signs of Benign Urethral Lesions in Girls?

The symptoms of benign urethral lesions in girls are based on the type of lesion your daughter may have.

Urethral Polyps

If your daughter has a urethral polyp, you may see a small mass sticking out of her urethra. You might also see blood in her urine or underwear, and she may have trouble peeing.

Paraurethral Cyst

Common symptoms of this type of lesion are:

  • a lump that can be felt
  • misdirected urinary stream
  • urinary block
  • painful urination (in an older child)

Urethral Caruncle

Some symptoms of a urethral caruncle are:

  • bleeding and pain when peeing
  • needing to pee often
  • sudden need to pee
  • outlet of the urethra is tender

Urethral Prolapse

Symptoms of urethral prolapse are bloody spotting and sometimes painful urination. Sometimes it can keep your daughter's body from getting rid of urine.



How Are Benign Urethral Lesions Diagnosed?

Cystoscopy
Cystoscopy
© 2010 Terese Winslow, U.S. Govt. has certain rights

Urethral polyps are found with a cystoscope. A cystoscope is a long, thin telescope with a light at the end that lets your urologist look inside the body. In children this is usually performed in the operating room under anesthesia. However, the key test to diagnosing benign urethral lesions is a voiding cystourethrogram (VCUG). VCUG is a type of x-ray test. VCUG uses a special dye infused into the urethra to show the structures.



Treatment

How a benign lesion is treated depends on the type. Your urologist has many methods to choose from to treat your lesions.

Urethral Polyps

Urethral polyps can be removed using cystourethroscopy. Your urologist can peer into the urethra with a small, flexible camera and use miniaturized tools to remove the growth.

Paraurethral Cyst

Paraurethral cysts don't need to be treated if there are no symptoms. Most often, these pop and shrink by themselves. But if there's a blockage, infection, or if pain occurs, your urologist may pierce the cyst with a scalpel blade to drain it and ease the symptoms.

Urethral Caruncle

Urethral caruncle cysts don't need to be treated if there are no symptoms. If the caruncle causes problems, your urologist may remove it and burn its base.

Urethral Prolapse

The good news for most sufferers of urethral prolapse is that it can be managed successfully. Milder forms of urethral prolapse can be managed by:

  • watching
  • sitz baths
  • estrogen cream
  • antibiotics (for infections)

In most cases, the problem should go away within weeks of treatment. For worse cases, surgery can be done to take out the prolapsed tissue. The membrane is then stitched in place to keep it from occurring again. A Foley catheter is placed inside the bladder before the procedure and removed after a day or 2.



What Can We Expect after Treatment for Benign Urethral Lesions?

Urethral Polyps

Surgery should take care of any symptoms. The problem shouldn't come back.

Paraurethral Cyst

Your daughter's urination should return to normal. The problem shouldn't come back.

Urethral Caruncle

Unless the caruncle is very large, a urethral catheter most likely won't be left in the bladder. Any growth that's taken out during the surgery will be tested to make sure there's no cancer. Peeing may be painful for a few days, and there may also be bloody spotting. The caruncle most often doesn't come back. But you should bring your daughter back to the urologist if she has further spotting or other irritating urination problems.

Urethral Prolapse

After the catheter is taken out, your daughter can return to her normal activities. The first few days after surgery, there might be some bloody spotting and painful urination. Older children who can swallow pills may be given pain killers to ease the painful urination. It's rare for urethral prolapse to come back.



Frequently Asked Questions

Is there anything I did as a mother to cause urethral polyps in my child?

No. There are no known predisposing causes. A polyp is thought to be a defect that develops the first few weeks after an egg is fertilized.

Will these polyps come back after surgery?

No. There are no cases of polyps coming back after being removed.

Are paraurethral cysts dangerous?

As a rule, they're not dangerous. Paraurethral cysts are rare, benign masses that either resolve themselves or can be easily treated with a surgical cut.

Does urethral prolapse hurt my child?

Other than bloody spotting and local irritating symptoms, the prolapsed mucous tissue mostly isn't tender, unless it has been prolapsed for several days and becomes edematous or ulcerated.

What causes urethral prolapse?

The actual cause of this condition isn't known. Some theories are a racial predisposition, poor muscle attachment of the urethral mucosa, not enough estrogen, and bad positioning of the urethra.