Background: Urethral prolapse is an uncommon condition seen in pediatric and postmenopausal females. This is the first reported case of urethral prolapse in a healthy, nulliparous, reproductive-aged woman after strenuous exercise.
Case: A 29-year-old nulliparous, African-American woman presented with 3 days of vaginal pressure and pain, dysuria, and difficulty sitting. These symptoms occurred acutely after strenuous exercise. Examination revealed urethral prolapse and a urethral diverticulum. A short course of conservative therapy decreased symptoms. The patient was successfully treated with manual reduction under general anesthesia, along with correction of the urethral diverticulum. She has remained asymptomatic for more than 9 months.
Conclusion: This case strengthens the theory that weak connective tissue combined with repeated increases in intraabdominal pressure is a primary cause of urethral prolapse. Treatment is varied, but manual reduction has been shown to be effective. Resection should be reserved for recurrent or infarcted cases.