PANCE Blueprint Genitourinary (4%)

Circumferential protrusion of the distal urethra through the external urethral meatus. It is a rarely diagnosed condition that occurs most commonly in prepubertal girls and postmenopausal women

• Vaginal bleeding is the most common presenting symptom of urethral prolapse
• Upon examination, round, often doughnut-shaped protrusion mucosa is observed obscuring the urethral opening

DX: Diagnosis is clinical and urethral prolapse is often an incidental finding during a routine examination

• Routine evaluation with urograms and voiding cystourethrography is unnecessary except in patients who may have evidence of malignancy

TX: Treatment includes topical estrogen creams, Vaseline, and sitz baths

• Surgical excision is justified in young patients with symptomatic urethral prolapse or with recurrent urethral prolapse

Image: Urethral Prolapse Ligated Over a Foley Catheter by Okorie CO CC BY 3.0

Urethral Stricture is a narrowing of the urethra caused by injury, instrumentation (TURP), infection (typically with gonorrhea), and certain non-infectious forms of urethritis

• Presents with weak urinary stream, difficulty urinating, incomplete bladder emptying, and recurrent urinary tract infections
• May cause urinary retention, bladder stones, or hydronephrosis if left untreated
• A urethral stricture should be suspected in men with chronic obstructive voiding symptoms, especially if noninvasive studies (e.g., uroflowmetry, ultrasound postvoid residual measurement) demonstrate poor bladder emptying with a low peak rate of urine flow

DX: Patients suspected of having a urethral stricture should undergo cystourethroscopy, retrograde urethrogram (RUG) — gold standard, voiding cystourethrogram (VCUG), or ultrasound urethrography to establish the diagnosis

TX: Treatments include urethral dilation or stent placement

• An open urethroplasty is an option for longer, more severe strictures

Image: Retrograde urethrocystography demonstrates a single stenosis of the bulbar urethra, which is tight and long, associated with a large diverticula of the bladder CC BY 4.0