title: Benefits of primary surgical resection for symptomatic urethral prolapse in children.
abstract: OBJECTIVE
  Urethral prolapse (UP) is a complete eversion of the distal urethral mucosa through the external meatus. UP must be distinguished by examination from trauma, prolapsed ureterocele, tumors or sexual abuse. Its management remains controversial. The aim of the study was to promote the benefits of primary surgical management for UP.
  
  
  METHODS
  A retrospective multicenter review of children who received surgery for UP between 1991 and 2011 was carried out. Non-complicated UP was primarily treated conservatively. A total of 19 patients were referred for complicated UP and underwent resection of the prolapsed urethral mucosa.
  
  
  RESULTS
  The mean delay in diagnosis was 2.2 days (range 1-6) and the most common symptoms were vaginal spotting and bleeding. No predisposing factor was found, but most patients had a mean weight, height and BMI greater than the 50th percentile. All patients underwent surgery successfully. One patient experienced a complication, i.e., dysuria. There was no case of recurrence after a mean 28 months of follow-up.
  
  
  CONCLUSIONS
  Early detection is based on bedside examination. The first-line treatment strategy for uncomplicated UP should be conservative management. Surgical resection is safe and effective for patients with significant symptoms.
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 avenue Dominique Larrey, 87042 Limoges Cedex, France. Electronic address: q.ballouhey@gmail.com.
authors.forename: Q
authors.initials: Q
authors.lastname: Ballouhey
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Galinier
authors.affiliation: Service d'Urologie et de Transplantation, 1 avenue Jean Poulhes, Hôpital Rangueil, 31059 Toulouse cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Gryn
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 avenue Dominique Larrey, 87042 Limoges Cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Grimaudo
authors.affiliation: Service d'endocrinologie et de gynécologie pédiatrique, Hôpital des Enfants, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Pienkowski
authors.affiliation: Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 avenue Dominique Larrey, 87042 Limoges Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Fourcade
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D014522:Urethral Diseases / Q000601:surgery*
keywords: Pediatric; Surgical management; Urethral prolapse; Urogenital bleeding