Urethrocele occurs most frequently in African American girls < 10 years of age [1] and postmenopausal Caucasian women. Several etiologies have been postulated for its development such as estrogen deficiency, poor muscle tone or abnormality of muscles in the vicinity of the urethra [2] [3], and treatment of stress urinary incontinence with bulking agents [4]. It has also been reported to occur spontaneously [5] or could be hereditary [6].

Two types of presentations are noticed clinically depending on the age group: prepubertal and postmenopausal. In prepubertal patients, urethrocele is usually asymptomatic and is noticed incidentally. In symptomatic patients, spotting of underclothes and a periurethral mass are the common features with urinary complaints, acute retention of urine [7] and strangulation being rare. Pain in the genital region may be reported if the urethrocele becomes thrombosed.

Postmenopausal patients present with bleeding per vagina and urinary symptoms such as hematuria, dysuria, increased urinary frequency, urinary tract infections and nocturia. Patients may complain of pelvic or genital pain with a feeling something coming out of the vagina with dyspareunia. Symptoms can worsen with coughing or straining. Urethrocele strangulation is more frequently reported amongst postmenopausal women compared to prepubertal patients.

Urethrocele is diagnosed after a complete history and a thorough pelvic exam with and without straining or coughing. It can be present concomitantly with a cystocele or uterine prolapse and should be differentiated from inflamed Bartholin and Skene glands. On examination, the urethrocele is seen as a pinkish or reddish ulcerated mucosal mass around the external meatus, protruding [8] through the anterior aspect of the vagina. In prepubertal patients, the mass is located in the middle of the external urethral meatus while in postmenopausal adults, the prolapsed mass protrudes through the meatus. If the urethrocele is thrombosed or strangulated, it may appear bluish in color. Examination of pediatric patients should ideally be performed during voiding or after catheterization of the central opening of the urethra which is visualized in the prolapsed mass. General anesthesia may be required to perform the exam in pediatric patients. Cystourethroscopy is useful to detect the urethrocele in postmenopausal women.

Radiological tests such as a pyelogram and voiding cystourethrogram are usually not required to diagnose the condition. They may be ordered if an underlying malignancy or anatomical abnormality is suspected. Magnetic resonance imaging (MRI) is the preferred modality for evaluating a urethrocele [9].

Histologically, the urethrocele mucosa appears edematous, thrombosed with scanty inflammation.

Treatment for urethrocele depends on the severity of symptoms and the impact on the patient's life. Conservative management includes pelvic floor exercises, such as Kegel exercises, to strengthen the pelvic muscles. Pessaries, which are devices inserted into the vagina to support the urethra, may also be used. In more severe cases, surgical intervention may be necessary to repair the prolapse and restore normal anatomy. Surgical options vary and should be tailored to the individual patient's needs.

The prognosis for urethrocele is generally good, especially with appropriate treatment. Many women experience significant improvement in symptoms with conservative measures or surgical repair. However, recurrence of prolapse can occur, and ongoing management may be required. Regular follow-up with a healthcare provider is important to monitor the condition and address any new symptoms promptly.

Urethrocele is primarily caused by weakening of the pelvic floor muscles and connective tissues. Factors contributing to this weakening include childbirth, especially multiple or difficult deliveries, aging, hormonal changes during menopause, obesity, and chronic straining due to constipation or heavy lifting. Genetic predisposition may also play a role in the development of pelvic organ prolapse, including urethrocele.

Urethrocele is a common condition among women, particularly those who have given birth. It is estimated that nearly half of women over the age of 50 experience some form of pelvic organ prolapse. The prevalence increases with age, and it is more common in women who have had multiple pregnancies. However, the exact prevalence of urethrocele alone is difficult to determine, as it often occurs alongside other types of prolapse.

The pathophysiology of urethrocele involves the weakening and stretching of the pelvic floor muscles and connective tissues that support the urethra. This weakening can result from mechanical stress during childbirth, hormonal changes, or other factors that compromise tissue integrity. As the support structures fail, the urethra descends into the vaginal wall, leading to the symptoms associated with urethrocele.

Preventing urethrocele involves maintaining the strength and health of the pelvic floor muscles. Regular pelvic floor exercises, such as Kegel exercises, can help strengthen these muscles. Maintaining a healthy weight, avoiding heavy lifting, and managing chronic conditions like constipation can also reduce the risk. For women who have given birth, postpartum pelvic floor rehabilitation may be beneficial in preventing prolapse.

Urethrocele is a condition where the urethra prolapses into the vaginal wall due to weakened pelvic support structures. It presents with urinary symptoms and pelvic discomfort, and diagnosis involves a combination of physical examination and diagnostic tests. Treatment ranges from conservative measures to surgical intervention, with a generally good prognosis. Understanding the risk factors and pathophysiology can aid in prevention and management.

For patients, understanding urethrocele is important for managing symptoms and seeking appropriate care. If you experience symptoms like urinary incontinence, pelvic pressure, or a vaginal bulge, it is important to discuss these with your healthcare provider. Treatment options are available, and many women find relief through exercises, devices, or surgery. Maintaining pelvic health through exercises and lifestyle modifications can also help prevent or manage this condition.

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