Clinical characteristics of urethral prolapse in Japanese children.

Background: Urethral prolapse (UP) in children is a rare condition and has commonly been reported in black girls. The aim of this study was to clarify the status of medical management for UP in Japanese children.

Methods: A secondary data analysis was conducted in Japanese children ≤15 years old with UP. The relationship between initial treatment approach and outcome was investigated, with symptom persistence or recurrence defined as treatment failure.

Results: Of 77 cases of UP in Japanese children reported since 1972, initial surgical treatment was performed in 42 cases (55%) and non-surgical treatment in 35 cases (45%). Underlying conditions constituting possible causative factors were present in 26 cases (34%) in total. Treatment outcome was evaluated in 59 cases (surgical treatment, n = 28; non-surgical treatment, n = 31) during a median follow-up period of 10 months. The rate of treatment failure was significantly higher in the non-surgical (81%, 25/31) than in the surgical treatment group (18%, 5/28; risk ratio, 4.2; 95%CI: 2.0-8.9; P < 0.001). Topical estrogen cream, a standard management worldwide, is not available as a prescription drug in Japan, and therefore was able to be used in only seven cases (20%) in the non-surgical treatment group.

Conclusions: Surgical treatment is more effective than non-surgical treatment in Japanese children, but both failure rates are high compared with that in non-Asian children. Drug approval revision for prescription use of estrogen cream, centralizing treatment to specialized facilities, and an active policy of surgical management in cases of non-surgical treatment failure may improve treatment outcomes for pediatric UP in Japan.