Urethral Prolapse with Vulvar Tumor-Like Mass Diagnosed by Magnetic Resonance Imaging: a Case Report and Literature Review

Abstract

Urethral prolapse is a rare condition not frequently encountered by gynecologists. However, patients with urethral prolapse occasionally visit gynecologists initially because the most common early symptom is genital bleeding. In this study, we report the case of a postmenopausal woman with severe urethral prolapse that could not be diagnosed by inspection alone but was successfully diagnosed by magnetic resonance imaging (MRI). An 89-year-old postmenopausal woman who complained of genital bleeding and incontinence had an erosive 3-cm vulvar mass. Because inspection alone was insufficient for diagnosis, MRI was performed. MRI revealed that the mass was not a tumor but protruding edematous urethral mucosa. We suspected urethral prolapse based on MRI results, and surgical excision was performed by urologists at another hospital. The excised tissue was composed of normal urethral mucosa under a microscope, and the diagnosis of urethral prolapse was pathologically confirmed. Her symptoms resolved after surgery with no recurrence. It is difficult for gynecologists to diagnose severe urethral prolapse by inspection alone. However, as described here, MRI can resolve this problem and is useful in eliminating diagnoses such as malignant vulvar tumor and condyloma. When inspection alone is insufficient to diagnose vulvar masses, MRI can be used as a supplemental investigative modality to aid in correct diagnosis.