Excision of Urethral Prolaps
Excise = to cut out or remove
Urethra = the tube through which one urinates
Prolapse = protrusion of
The urethra, like any other part of the body, is made up of different layers. The mucosa is the innermost layer, and is therefore in direct contact with the urine. A mucosal prolapse is when the distal portion (portion near the end of the urethra) of mucosa everts out or prolapses through the urethral meatus (opening or end of the urethra). It typically looks like a pink to purple mass and can be confused with a tumor. The area is often tender to touch, and is friable(bleeds easily with only minor irritation). This condition is seen in girls younger than 12 and is far more common in African Americans.
A urethral prolapse may revert spontaneously with warm baths and observation. Those that are very severe, fail to revert on their own, or are recurrent, require a surgical procedure. Excision is a short procedure and is performed on an ambulatory basis.
As with any procedure in which anesthesia is administered, you will be asked not to feed your child anything (including any liquids) after midnight on the evening prior to the surgery. If your child is on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. If safely avoidable, the procedure should not be performed if your child is on, or has recently been taking any medication that may interfere with his ability to clot his blood. This is rarely of any concern since the procedure is so minor. The most common of these medications are aspirin-like compounds and all related pain relievers, fever reducers or anti-inflammatory compounds(whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past ten days. If his medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed any of the current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
To review the basics of what we discussed in the office: The procedure usually takes less than one hour. Your child will be placed under general anesthesia so that she feels nothing and has no awareness of the surgery. The excess mucosal tissue is removed so that the remaining mucosal layer is even with the outer layers of the urethra. The edges of the mucosa are then sewn together to the outer layers of the urethra. The sutures stop any bleeding on the edges, and more importantly helps the mucosa to stay in place while it is healing.
Your child will be in the recovery room for a short time before being sent home. She may have some discomfort, but usually not any severe pain. You may see a small drop of blood drip from the area. Try to keep the surgical area dry for 24 hours. We ask that she refrain from any strenuous activity or rough play for a few days. Some patients have almost no discomfort while others are somewhat uncomfortable for one to two days; longer is rare. Your child may cry the first few times that she urinates. She may have a stinging or burning sensation from the urine hitting the recently cut tissue edge. For discomfort, she may have any pediatric-dose over-the-counter medicine to which she is not allergic (Tylenol®, Advil®, or other ibuprofen product). Some surgeons may instruct you to put your child in the warm bath a couple of times per day. Warm baths may also help your child urinate if she is holding back.
The sutures we use are self-dissolving, and do not require removal. You may be asked to apply an antibiotic ointment (i.e. Bacitracin®) to the area to prevent the sutures or skin from sticking to undergarments.
Expectations of Outcome
Again, there may be a stinging or burning sensation the first few times that your daughter urinates. Try to encourage her not to hold her urine back. Again, sitting in the warm bath may help.
It is uncommon for a prolapse to recur. The sutures will break and fall out on their own in one to three weeks. If you happen to notice that a suture breaks early (that day or within a couple of days), you need not be concerned. It probably has already served its purpose. Again, do not be alarmed by a little bit of blood oozing for a couple of days.
Possible Complications of the Procedure ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in the consultation, we would like you to have a list so that you may ask questions if you are still concerned. Aside from anesthesia complications, it is important that parents be made aware of all possible outcomes which may include, but are not limited to:
- Recurrent Prolapse: Again, this is uncommon.
In the rare instance, the procedure would be repeated.
Infection: Infection is unusual following this procedure, but is possible in any procedure. Usually, local wound care and antibiotics are sufficient.
- Meatal Stenosis: Sometimes, the opening can scar down and become too narrow. If so, it may obstruct the flow of urine. A minor surgical procedure may be necessary to open the meatus to a normal caliber.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure there liability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.
Delta Medix, P.C.