Urethrocele - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Urethrocele is a condition in which the urethra moves from its original place and presses against the vagina. The urethra is a small tube connected to the urinary bladder that drains urine out of the body. Urethrocele occurs due to the weakening of the tissues and muscles responsible for keeping the urethra in place. It is one of the various types of prolapse affecting females. It is also known as an anterior vaginal prolapse.

What Causes Urethrocele?

The urethra is held in position by a thick layer of muscles and tissues, known as the pelvic floor. Some situations and conditions might cause the pelvic floor muscles and tissues to lose their strength, causing them to stretch, thus preventing them from holding the urethra. The urethra, a straight tube-like structure, then curves and widens, pressing against the vaginal wall. It is not clearly understood what causes urethral prolapse.

What Are the Risk Factors Associated With Urethrocele?

The risk factors or conditions might increase the chances of developing urethral prolapse. They are:

• Pregnancy and Children - The most common reason for urethral prolapse is pregnancy and childbirth. The strain of holding the baby, along with the pressure of labor and vaginal delivery, weakens the pelvic floor muscles and tissues.

• Age - The pelvic muscles gradually weaken along with progressing age. Postmenopausal women are more likely to develop urethral prolapse. The hormone estrogen is essential for providing muscle strength. As estrogen levels decrease during menopause, the muscles begin to weaken. Thus, the pelvic floor muscles become weak with aging.

• Congenital Defects - Certain individuals are born with weak pelvic floor muscles. Thus specific rare incidences of congenital disabilities of the pelvic floor make prolapse more likely in younger people who have not become pregnant.

• Increased Abdominal Pressure - Increased pressure on the pelvic floor muscles can lead to their weakening. Certain conditions that increase abdominal pressure are:

• Regularly lifting heavy objects.

• Obesity.

• Chronic cough.

• Frequent straining while passing motion.

• Presence of pelvic mass such as fibroids or polyps.

• Previous Pelvic Surgery - In case of past surgeries for urethral prolapse or any other organ prolapse, one is at an increased risk for urethral prolapse.

What Are the Symptoms of Urethrocele?

Individuals with mild or minor urethrocele usually remain asymptomatic. In the case of severe prolapse, symptoms include:

• Vaginal irritation.

• A feeling of fullness or pressure in the vagina and pelvic region.

• Discomfort in the pelvic area.

• Stress incontinence (a condition where the person cannot empty the bladder).

• Painful sex.

• Pelvic organs bulge out of the urethral opening.

• Recurrent urinary tract infections (repeated urinary tract infections comprise the kidneys, ureters, bladder, or urethra).

How Is Urethrocele Classified?

Urethrocele is classified according to the severity of the protrusion:

• First-degree Prolapse - The urethra is slightly pushed against the vaginal walls or dropped towards the urethral opening.

• Second-degree Prolapse - This means that the urethra extends to the vaginal or urethral opening, or there is a collapse of the vaginal walls.

• Third-degree Prolapse - The organs protrude outside the vaginal or urethral opening.

How Is Urethrocele Diagnosed?

The diagnosis of urethrocele is made by:

• Thorough physical examination.

• Urinalysis - A urinalysis is a urine test to detect and manage various disorders like urinary tract infections, kidney diseases, and diabetes. Urinalysis tests the appearance, concentration, and urine content.

• Urinary Stress Test - A urinary stress test, also known as a bladder stress test, stimulates accidental urine drainage through coughing, sneezing, laughing, or exercise.

• X-ray Scans - X-ray scans are imaging techniques that use X-rays to detect the presence of abnormalities in the internal organs.

• Urine Culture - A urine culture is a lab test to detect the presence of bacteria or other microbes in the urine sample. It is used to check for the presence of urinary tract infections.

How Is Urethrocele Treated?

Minor cases of urethrocele are asymptomatic and do not require treatment. However, treatment is needed for advanced cases of urethrocele. The treatment depends upon the severity, health conditions, and future pregnancy plans.

Non-surgical Treatment:

• Pessaries - Pessaries are silicone devices placed in the vaginal canal to help maintain its structure. They come in various shapes and sizes. This is a non-invasive procedure that is recommended before any other treatment.

• Topical Hormones - Topical hormones such as estrogen creams can be used to compensate for the loss of hormones in menopausal women and boost the strength of the weakened tissues and muscles.

• Pelvic Floor Exercises - Pelvic floor exercises, also known as Kegel exercise, helps one to tone the pelvic organs. Kegel exercise, an individual should hold an object in line with the vaginal canal and contract tightly for one to two seconds. Then relax for 10 seconds. This should be repeated ten times, several times a day.

• Lifestyle Changes - Obesity weakens the muscles, so losing some weight removes pressure from the pelvic area. In addition, treating any underlying medical condition impacting the pelvic floor muscles can help eliminate stress. Avoiding heavy lifting objects can also remove unnecessary stress.

Surgical Treatment:

In case of ineffectiveness of non-surgical treatments, the doctor might recommend surgery.

• Anterior Vaginal Wall Repair - This surgery strengthens the supporting structures. The recovery after surgery could take around six weeks. During anterior vaginal wall repair surgery, the surgeon makes an incision in the vaginal wall and repositions the bladder to its normal position. The surgeon may also use sutures or mesh to support the bladder and keep it in place. The procedure can be performed under general or regional anesthesia and may be done as an outpatient or with a short hospital stay. Recovery time can vary, but most women are able to resume normal activities within a few weeks after surgery.

What Is the Outlook of Urethrocele?

Mild urethrocele is usually asymptomatic and does not cause any symptoms. However, as the condition progresses, the situation becomes uncomfortable. There are several treatment options available for treating urethroceles. The prognosis is good for people with severe urethrocele and can find long-term relief.

Conclusion:

Urethrocele is a rare condition in which the urethra shifts from its original place and presses against the vagina. The condition occurs due to the weakening of the pelvic floor muscles that help keep the urethra in its place. Several causes lead to urethrocele. Mild urethrocele is usually asymptomatic, whereas the severe forms require treatment. The treatment ranges from non-surgical to surgical. The outlook is favorable if detected and treated early. The doctor can help determine the condition's cause and recommend the best treatment for the individual.