The peak age for urethral prolapse in prepubertal children is to years The majority of children with urethral prolapse present with vaginal bleeding A doughnut-shaped protrusion from the vulva is found in urethral prolapse Prompt attention is needed to correct the prolapse to avoid tissue necrosis Urethral prolapse is the protrusion of the distal urethral mucosa outward through its meatus, with a cleavage plane between the longitudinal and circularoblique smooth-muscle layers of the urethra Most prolapses happen spontaneously, but some episodes are noted to have occurred following a sudden or recurrent increase in intra-abdominal pressure (coughing, straining with constipation, lifting heavy objects) The prolapsed segment is constricted at the meatus and venous blood flow is impaired, so the involved tissue becomes swollen, edematous, and dark red or purplish If the urethral prolapse is not corrected, the tissue can become thrombosed and necrotic About half of affected females are prepubertal children, while the majority of the remainder are postmenopausal women Most urethral prolapses during childhood occur between the ages of and 10 years, with the peak at to years of age The majority of prepubertal children with urethral prolapse are African Americans Clinical Manifestations Vaginal bleeding or spotting is the chief complaint of 90% of children with significant urethral prolapses The bleeding is painless, occasionally misinterpreted as hematuria or menstruation, and is sometimes accompanied by urinary frequency or dysuria On examination of the child’s perineum, a red or purplish, soft, doughnut-shaped mass is seen ( Fig 92.6 ) Most prolapses are not tender and measure to cm in diameter By retracting the labia majora posterolaterally, the examiner can often demonstrate that the mass is separate from and anterior to the vaginal introitus; this process may be difficult if the prolapse is large A small central dimple in the mass indicates the urethral lumen, though the dimple can be missed if lighting is inadequate, bleeding is active, or mucosal edema is significant In most cases, the appearance of the prolapse is diagnostic However, if the diagnosis is in doubt, sterile straight catheterization of