Benign (Not Cancerous) Urethral Lesions in Children - Girls
Benign lesions in the urinary tracts of young girl are rare, but when they occur they can cause problems. Following is a quick primer on the conditions your daughter may experience.
What happens under normal conditions?
Under normal conditions, every young girl should be able to urinate freely with no pain, blockage or irregular streams.
What are some types of benign lesions in girls?
Urethral polyps: A urethral polyp is an irregularity existing at birth. It is usually composed of fibrous tissue but may include some smooth muscle, small cysts or nerve tissue all covered by a thin protective layer of tissue. If your daughter has a urethral polyp, there may be a small mass coming out of the urethra, blood in the urine and or difficulty urinating. Urethral polyps are diagnosed with cystoscopy, a endoscopic technique that allows a urologist to readily view the polyp, and/or a voiding cystourethrogram (VCUG). By combining an X-ray of the urethra with dye in the area, the doctor can easily view the structures.
Paraurethral cyst: Also known as Skene's glands, paraurethral glands are located in the urethrovaginal wall at the opening into the urethra in females. In a newborn, Skene's duct can become blocked by a large cyst filled with hormone secretions that may even replace the urethral opening. It can also be confused with other irregularities, such as a prolapsed ureterocele which is a hernia at the end of the ureter that joins the bladder. But the major difference is that ureteroceles spontaneously move back into the organ. A paraurethral cyst will be evident to a doctor by its appearance — a glistening, tense and bulging yellowish-white mass reducing the size of the urethral opening. Other symptoms include a misdirected urinary stream and possibly painful urination.
Urethral caruncle: Urethral caruncles are benign polypoid (or stalk-like) masses, hanging from one area of the external urethral opening. Urethral caruncles are rare in childhood. The primary sign of this problem is a thin, reddish membrane protruding from one portion of the urethral opening. Other symptoms include bleeding and urination problems (frequency, urgency and pain). It is usually spotted on an examination with no symptoms present.
Urethral prolapse: Urethral prolapse is defined as a circular protrusion of tissue through the urethral opening believed to be caused by poor attachments between the muscle layers. It is predominant in pre-pubescent black girls around age five with less than 10 percent of cases occurring in white girls.
The child usually has bloody spotting and occasionally painful urination. Upon examination, the urologist may find a doughnut-shaped mass of varying size surrounding the urethral opening, just above the vaginal opening. It may appear as if it is hemorrhagic, or red with blood ready to burst, and, in the most serious cases, might be ulcerated, infected and even gangrenous. Because of these classic appearances, this condition is rarely confused with other prolapsed ureteroceles or protruding vaginal masses. If there are questions about the diagnosis, your child's urologist will likely order a pelvic ultrasound.
To confirm the diagnosis, he or she may also wish to have your daughter urinate while watching the stream flow through the prolapsed urethra. In more than 20 percent of cases, urethral prolapse is misdiagnosed as vaginal bleeding.
Risk factors for this problem include a hereditary predisposition, particularly among blacks, urinary tract infections, constipation and increased abdominal pressure. Although unlikely, chronic cough, asthma and trauma to the area may also increase the risk.
How are benign lesions in girls treated?
Urethral polyps: Treatment consists of removal of the polyp using cystourethroscopy, a minimally-invasive technique using a fiber-optic instrument that allows the urologist to peer into the space and, with additional miniaturized instruments, remove the growth.
Paraurethral cyst: If there are no symptoms, with the exception of the cyst, no treatment is necessary. These usually spontaneously rupture and decompress. If, however, a blockage develops, the urologist may pierce the cyst with a scalpel blade to relieve the milky drainage.
Urethral caruncle: For patients who have no symptoms, the primary treatment option is reassurance. If the caruncle is large or small and causing problems, the urologist will probably choose to remove the growth and cauterize the base.
Urethral prolapse: The good news for most sufferers of urethral prolapse is that it can be managed successfully. Milder forms of urethral prolapse necessitate conservative management, including observation, sitz baths, topical estrogen cream and antibiotics for infections. Under ordinary circumstances, the problem should resolve within weeks of treatment. A relatively simple outpatient surgical removal provides excellent results for more severe, stubborn cases. A Foley catheter is placed inside the bladder before the procedure and removed after a day or two.
What can be expected after treatment for benign lesions in girls?
Urethral polyps: Surgery should resolve any symptoms. There should be no recurrence.
Paraurethral cyst: Normal urination should resume. There should be no recurrence. There is no need for preventive measures.
Urethral caruncle: No indwelling urethral catheter is needed unless the caruncle is very large. Any growth that is removed is biopsied to ensure that it is a benign lesion. Urination may be painful for a few days and there may also be bloody spotting. The caruncle usually does not recur but patients should return for reevaluation if they have further spotting or other irritating urination problems.
Urethral prolapse: Regular activities may be resumed once the catheter is removed. Recurrence of this problem is rare. Some painful urination and bloody spotting may occur the first few days after surgery. If an older child can swallow pills, a prescription for an analgesic may be administered to relieve the painful urination.
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. This is believed to be an irregularity that develops the first few weeks after an egg is fertilized.
Will these polyps come back after surgery?
No. There are no cases of recurrent polyps after removal.
Are paraurethral cysts dangerous?
Generally they are not dangerous. Paraurethral cysts are rare benign masses that either resolve themselves spontaneously or can be easily treated with a surgical incision.
Does urethral prolapse hurt my child?
Other than bloody spotting and local irritating symptoms, the prolapsed mucous tissue usually is not tender.
What causes urethral prolapse?
The actual cause of this condition remains unknown. But various theories include a racial predisposition, poor muscle attachment of the urethral mucosa, estrogen deficiency and bad positioning of the urethra.
Reviewed January 2011