Benign Urethral Lesions in Children – Girls
Although rare, benign lesions in the urinary tract in girls may still develop and cause significant problems. Normally, young girls should be able to urinate comfortably and without pain or obstruction.
What are the types of benign lesions in girls?
These are some forms of benign lesions that are normally seen developing in young girls:
Urethral polyps develop in the fetal stage. This is an abnormal mass of fibrous tissue which may also include some smooth muscles, small cysts or even nerve tissues in some cases. This mass is covered with a thin layer of tissue as well.
In case the girl child has a urethral polyp, a lump in the vulva, blockage and blood in the urine can be observed. Cystoscopy is efficient in diagnosing urethral polyps in girls. This is a minimally invasive technique that uses a fiber-optic instrument to view the insides of the urinary system without pain and discomfort to the child. VCUG (voiding cystourethrogram) is another effective diagnostic test for determining urethral polyps in girls. This is performed by injecting a contrast dye first and then taking x-ray images which helps to highlight the urinary system visibly.
These are also called as ‘Skene’s glands’ and are located at the opening of the urethra, in the urethrovaginal wall, in females. In newborn children, Skene’s duct becomes blocked by a large cyst which is filled with hormone secretions and may even replace the urethral opening.
It is often confused with other abnormalities, including prolapsed Ureterocele which is actually a hernia formed at the end of the ureter which joins further on with the bladder. A noticeable difference between these two conditions is that in Ureteroceles, it moves back instantly into the organ. Paraurethral cysts can be distinguished by their appearance as they are tense and bulging yellowish white mass which glisten distinctly and cause obstruction in the urethral opening. Often, it is accompanied by painful urination and misdirected urinary stream.
Urethral caruncle is a benign polypoid (stalk-like structures) mass which can be seen attached to the external urethral opening. These are rarely seen in children. A thin red-colored membrane protruding from the urethral opening signifies the development of urethral caruncle. Symptoms may also include urination problems such as bleeding. It is usually detected during a routine physical examination.
Urethral prolapse is seen as a circular protrusion made of tissue protruding from the urethral opening in girls. This is believed to be the result of poor connection between the muscle layers. Pre-pubescent black girls of 5 years of age are more prone to this condition, whereas around 5% of Caucasian girls are known to be affected by this.
Blood spotting and occasionally painful urination is seen in the affected child. Examination may show a doughnut-shaped mass of varying sizes in the urethral opening, present above the vaginal opening. It may also appear to be hemorrhagic and ready to burst, and in severe cases it might get ulcerated, infected and even develop gangrene. This typical appearance often results in confusing it with other protruding vaginal masses and prolapsed Ureterocele. Pelvic ultrasound is most useful in determining this condition.
Observing the urination process of the girl child (stream flow) through the prolapsed urethra is an effective way to diagnose this condition. In over 20% of such cases, urethral prolapse are likely to be wrongly diagnosed as vaginal bleeding.
Genetic predisposition is especially seen among blacks as being one of the major risk factors for this condition. Apart from this, urinary tract infections (UTI), increased abdominal pressure and constipation are also some of the other risk factors. Chronic cough, asthma and trauma to the pelvic region are lesser risk factors for development of urethral prolapse.
How are benign lesions in girls treated?
There are different treatment methods for the several types of benign lesions in girls.
Urethral polyps - Minimally invasive surgical technique called a cystourethroscopy is used to remove the polyps. A fiber-optic viewing instrument allows the urologist to view the troubled area and perform the surgical removal of the polyp using miniaturized surgical instruments.
Paraurethral cyst - In case there are no symptoms apart from the cyst, treatment may not be required. These usually rupture and decompress with time. However, in case there is significant blockage then the urologist may burst the cyst using a scalpel blade to drain the discharge within it.
Urethral caruncle - In case the patient does not exhibit any symptoms, no treatment may be required. In case the caruncle is large in size and causing significant problems, then the urologist may remove the abnormal growth and cauterize its base to prevent further growth.
Urethral prolapse - Most cases of urethral prolapse can be easily managed. Mild forms of urethral prolapse require conservative treatment – observation, sitz baths, topical estrogen cream or antibiotics for prevention of infection, etc. Normally, this condition resolves itself within weeks of such treatment.
In case of significant problems in severe cases, the urologist may remove the prolapse with minor surgery (outpatient procedure). A Foley catheter is placed within the bladder for a couple of days following surgery.
How is the prognosis following treatment of benign lesions in girls? For:
Urethral polyps – Surgery resolves the noticeable symptoms effective and there should not be any recurrence.
Paraurethral cyst – Normal urination is achieved post-treatment and there is no recurrence. No preventive measures are need after successful treatment.
Urethral caruncle – No catheter is needed to be attached unless the size of the caruncle is significantly large. The removed tissue mass is sent for detailed analysis in a pathology laboratory to ensure its benign nature. Pain is felt normally for a few days while urinating and often blood spotting is reported. Although the risk of recurrence is low, the patient is advised for regular check-up if the urination problems and blood spotting is observed for long.
Urethral prolapse – The patient can resume regular activities once the catheter has been removed. Recurrence is only seen in rare cases. At times, painful urination and blood spotting may also be observed following the surgery. For older girls, oral analgesics help to alleviate pain.