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Background <p>Urethral mucosa prolapse is a rare entity, more commonly reported in black prepubertal and white postmenopausal females. It usually presents as a urethral mass, abnormal bleeding, urethral pain, dysuria, voiding difficulty, and rarely with acute urinary retention. Diagnosis is more often clinical and is depicted by the urethral opening in the center of the circumferential urethral mass protruding out of the urethral meatus. Other entities like urethral caruncle, prolapse of the ureteric cyst, and smaller masses can be given a trial with topical estrogen application after condyloma, ureterocele, skene gland cyst, and urethral rhabdomyosarcoma have been excluded. The treatment for larger masses includes excision.</p> Case Presentation <p>A postmenopausal female presented with lower urinary tract infections, intermittent hematuria and voiding lower urinary tract symptoms since two months. She had no history of medical comorbidities, topical estrogen use, surgical intervention or similar episode in past. Examination revealed a urethral mass which was unhealthy looking, thrombosed, non-necrotic, firmer in consistency, bleeding on touch making it suspicious of urethral malignancy. She underwent magnetic resonance imaging and urethrocystoscopy confirming a localized inflammatory pathology. She was given a trial of oral antibiotics and topical estrogen application, after which the mass reduced significantly. This is followed surgical excision of the prolapsed mucosa.</p> Conclusions <p>Urethral mucosa prolapse is a common condition in postmenopausal females owing to estrogen deficiency, but can be easily recognized by its circumferential protuberance in continuation with the urethral meatus. Sometimes it can get inflamed and strangulated, mimicking thrombosed piles or bleed on touch with variegated appearance mimicking urethral malignancy. A detailed careful clinical differentiation, ultrasonographic imaging with Doppler study, magnetic resonance imaging, urethrocystoscopy and biopsy can help reach the diagnosis. Also, the potential role of dietary changes (phytoestrogens), Gamma Levulinic Acid, and local estrogen as follow-up treatment would be helpful for clinicians.</p>

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Urethral Mucosa Prolapse Masquerading as Urethral Malignancy in Postmenopausal Women

  • 期刊论文

  • 发表日期：

    2025年9月15日

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  • Arunima Saini,
  • Ankur Mittal,
  • Vikas Kumar Panwar,
  • Deepak Dubey

摘要

Background

Urethral mucosa prolapse is a rare entity, more commonly reported in black prepubertal and white postmenopausal females. It usually presents as a urethral mass, abnormal bleeding, urethral pain, dysuria, voiding difficulty, and rarely with acute urinary retention. Diagnosis is more often clinical and is depicted by the urethral opening in the center of the circumferential urethral mass protruding out of the urethral meatus. Other entities like urethral caruncle, prolapse of the ureteric cyst, and smaller masses can be given a trial with topical estrogen application after condyloma, ureterocele, skene gland cyst, and urethral rhabdomyosarcoma have been excluded. The treatment for larger masses includes excision.

Case Presentation

A postmenopausal female presented with lower urinary tract infections, intermittent hematuria and voiding lower urinary tract symptoms since two months. She had no history of medical comorbidities, topical estrogen use, surgical intervention or similar episode in past. Examination revealed a urethral mass which was unhealthy looking, thrombosed, non-necrotic, firmer in consistency, bleeding on touch making it suspicious of urethral malignancy. She underwent magnetic resonance imaging and urethrocystoscopy confirming a localized inflammatory pathology. She was given a trial of oral antibiotics and topical estrogen application, after which the mass reduced significantly. This is followed surgical excision of the prolapsed mucosa.

Conclusions

Urethral mucosa prolapse is a common condition in postmenopausal females owing to estrogen deficiency, but can be easily recognized by its circumferential protuberance in continuation with the urethral meatus. Sometimes it can get inflamed and strangulated, mimicking thrombosed piles or bleed on touch with variegated appearance mimicking urethral malignancy. A detailed careful clinical differentiation, ultrasonographic imaging with Doppler study, magnetic resonance imaging, urethrocystoscopy and biopsy can help reach the diagnosis. Also, the potential role of dietary changes (phytoestrogens), Gamma Levulinic Acid, and local estrogen as follow-up treatment would be helpful for clinicians.