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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

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Benign (Not Cancerous) Urethral Lesions in Children - Girls Glossary
  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • analgesic: A drug intended to alleviate pain.

  • antibiotic: Drug that kills bacteria or prevents them from multiplying.

  • benign: Not malignant; not cancerous.

  • biopsied: Tiny piece of a body part that was removed with a needle or during surgery and examined under a microscope to determine if cancer or other abnormal cells are present.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • caruncle: Fleshy growth.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • cauterize: Close a wound or destroy abnormal or infected tissues with a heated instrument, laser or electric current.

  • chronic: Lasting a long time. Chronic diseases develop slowly. Chronic renal (kidney) failure may develop over many years and lead to end-stage renal (kidney) disease.

  • constipation: A condition in which a person has difficulty eliminating solid waste from the body and the feces are hard and dry.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cystoscopy: Also known as cystourethroscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

  • cystourethrogram: Also called a voiding cystogram. A specific X-ray that examines the urinary tract. A catheter (hollows tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body)and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The X-rays will show if there is any reverse flow of urine into the ureters and kidneys.

  • cystourethroscopy: Also known as cystoscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

  • cysts: Abnormal sacs containing gas, fluid or a semisolid material.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • endoscopic: A procedure performed in order to examine the bladder.

  • estrogen: Female hormone produced by the ovaries.

  • fibrous: Consisting of or resembling fibers.

  • frequency: The need to urinate more often than is normal.

  • gland: A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.

  • hernia: Condition in which part of an internal organ projects abnormally through the wall of the cavity that contains it.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • incision: Surgical cut for entering the body to perform an operation.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • invasive: Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

  • invasive: Not just on the surface; with regard to bladder cancer, a tumor that has grown into the bladder wall.

  • ions: Electrically charged atoms.

  • lesion: A zone of tissue with impaired function as a result of damage by disease or wounding. Examples are scars, abscesses, tumors and ulcers.

  • membrane: A thin sheet or layer of tissue that lines a cavity or separates two parts of the body. A membrane can act as a filter, allowing some particles to pass from one part of the body to another while keeping others where they are.

  • mucous tissue: A connective tissue in the umbilical cord and embryo.

  • paraurethral cysts: Cysts affecting the Skene's glands, which are located alongside the urethra.

  • paraurethral glands: Also called Skene's glands. These are singular tubular glands located alongside the urethra.

  • pelvic: Relating to, involving or located in or near the pelvis.

  • polyp: Small, stalk-like growth sticking out from the skin or from a mucous membrane.

  • prolapse: The protrusion or dropping of the uretus (uterine prolapse), rectum (rectocele) or bladder (cystocele) into the vagina.

  • prolapsed ureterocele: A ureterocele that has slipped into the neck of the bladder.

  • secretion: Process of producing a substance from the cells and fluids within a gland or organ and discharging it.

  • tissue: Group of cells in an organism that are similar in form and function.

  • topical: Describes medication applied directly to the surface of the part of the body being treated.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • ureter: One of two tubes that carry urine from the kidneys to the bladder.

  • ureterocele: The portion of the ureter closest to the bladder becomes swollen because the ureter opening is very tiny and obstructs urine outflow; urine backs up in the ureter tube.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urethral: Relating to the urethra, the tube tha carries urine from the bladder to outside the body.

  • urethral mucosa: Moist lining of the urethra.

  • urethral polyp: Non-cancerous growth in the urethra.

  • urethral prolapse: Forward or downward displacement of the urethra.

  • urethroscopy: Inspection of the urethra with a urethroscope.

  • urethrovaginal: Between the urethra and vagina.

  • urge: Strong desire to urinate.

  • urgency: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urinary tract infection: Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.

  • urinate: To release urine from the bladder to the outside. Also referred to as void.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • vagina: The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • VCUG: Also referred to as voiding cystourethrogram or voiding cystogram. A catheter is placed in the urethra and the bladder is filled with a contrast dye. X-ray images are taken as the bladder fills and empties to show any blockage or reverse urine flow.

  • void: To urinate, empty the bladder.

  • voiding: Urinating.

  • voiding cystourethrogram: Also referred to as VCUG or voiding cystogram. A specific X-ray that examines the urinary tract. A catheter (hollows tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body)and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The X-rays will show if there is any reverse flow of urine into the ureters and kidneys.

Benign (Not Cancerous) Urethral Lesions in Children - Girls Anatomical Drawings

click images for a larger view
 

 

 

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