Journal of minimally invasive gynecology · 2026
Management of Acute Thrombosed Urethral Prolapse.
СтатьяКлинический случайVideo-Audio MediaНазвание и аннотация: Перевод в очереди
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Pfeuti Courtney K, Linder Brian J
Аннотация
OBJECTIVE: Urethral prolapse is a common pathology that is often asymptomatic or presents with mild symptoms.1 Rarely, acute thrombosis or necrosis of the redundant urethral mucosa invokes persistent pain, necessitating prompt surgical intervention.1-3 The commonly used four-quadrant excisional technique may be challenging in acute presentations, therefore, we demonstrate key techniques to optimize the surgical approach.4 SETTING: Academic hospital system.
PARTICIPANT: A 77-year-old female was urgently referred from the ER due to acute urethral pain, bleeding, and inability to sit comfortably. Same day examination in our urogynecology clinic demonstrated dark red, edematous urethral mucosa protruding 1-2 centimeters beyond the vaginal epithelial edge from 9 to 3 o'clock with a 4-centimeter friable, necrotic lesion at 6 o'clock (Fig. 1).
INTERVENTION: Given her acute presentation and preference for surgical management, rigid urethroscopy, excision of urethral prolapse, and urethroplasty was expedited (Video). First, urethroscopy was performed to evaluate urethral coaptation in the proximal urethra. A four-quadrant approach was performed to excise the thrombosed urethral prolapse. Bilateral Allis clamps provided traction and delineation of redundant urethral tissue. Absorbable stay sutures were placed in the urethral mucosa proximal to the planned incision to prevent mucosal retraction upon excision. Beginning at 12 to 3 o'clock, the prolapse was incised with needlepoint electrocautery at the urethral junction laterally and healthy mucosa medially. Interrupted absorbable sutures were used to reapproximate the vaginal epithelium and urethral mucosa. A similar process was performed from 12 to 9 o'clock followed by the dependent quadrants, which are often the most edematous, friable areas. An 18F transurethral catheter was left indwelling (Table 1).
CONCLUSION: Acute presentations of urethral prolapse often require surgical excision due to risk of necrosis and distressing symptoms. Symptomatic improvement and anatomic restoration can be achieved with circumferential excision of thrombosed urethral prolapse. Surgical techniques demonstrated here using a four-quadrant excisional approach may be helpful for acute presentations. VIDEO ABSTRACT.
PARTICIPANT: A 77-year-old female was urgently referred from the ER due to acute urethral pain, bleeding, and inability to sit comfortably. Same day examination in our urogynecology clinic demonstrated dark red, edematous urethral mucosa protruding 1-2 centimeters beyond the vaginal epithelial edge from 9 to 3 o'clock with a 4-centimeter friable, necrotic lesion at 6 o'clock (Fig. 1).
INTERVENTION: Given her acute presentation and preference for surgical management, rigid urethroscopy, excision of urethral prolapse, and urethroplasty was expedited (Video). First, urethroscopy was performed to evaluate urethral coaptation in the proximal urethra. A four-quadrant approach was performed to excise the thrombosed urethral prolapse. Bilateral Allis clamps provided traction and delineation of redundant urethral tissue. Absorbable stay sutures were placed in the urethral mucosa proximal to the planned incision to prevent mucosal retraction upon excision. Beginning at 12 to 3 o'clock, the prolapse was incised with needlepoint electrocautery at the urethral junction laterally and healthy mucosa medially. Interrupted absorbable sutures were used to reapproximate the vaginal epithelium and urethral mucosa. A similar process was performed from 12 to 9 o'clock followed by the dependent quadrants, which are often the most edematous, friable areas. An 18F transurethral catheter was left indwelling (Table 1).
CONCLUSION: Acute presentations of urethral prolapse often require surgical excision due to risk of necrosis and distressing symptoms. Symptomatic improvement and anatomic restoration can be achieved with circumferential excision of thrombosed urethral prolapse. Surgical techniques demonstrated here using a four-quadrant excisional approach may be helpful for acute presentations. VIDEO ABSTRACT.