Case series – Urethra diaries

A 38-year-old woman presented to the emergency department with sudden onset voiding dysfunction, vaginal pain and a new protruding vaginal mass following a sneezing episode.Her presenting creatinine was normal at 79 and GFR was 82.She has a past medical history of mild stress urinary incontinence, non-specified anxiety, and depression disorders on escitalopram daily, and has had two uncomplicated vaginal deliveries.Urogynecology was consulted for an irreducible vaginal prolapse as multiple attempts to reduce the bulge were unsuccessful.On examination, a purple mass was noted at the 6-o'clock position beneath the urethral meatus (Figure 1A).This appeared to be most in keeping with a thrombosed lesion.The patient was in significant pain. Diagnostic processTwo urogynecology staff examined the patient in the clinic.A Foley catheter was inserted, and urine sent for culture.Local anesthetic jelly was applied, and with patient consent the mass was drained of clots and serosanguinous fluid via a small scalpel incision.Monsel's solution was applied for hemostasis.The patient experienced immediate relief.The fluid was sent for culture and cytology.She was started empirically on Amoxicillin-Clavulanic Acid 875/125 mg as she KEY MESSAGES• A vaginal bulge is not always pelvic organ prolapse.• A periurethral mass may be a prolapsed bladder lesion or urethral leiomyoma.• Examine the mass to its base to identify its origin: this may require imaging or cystoscopy CUAJ -Resident's Room Le Gallee et al Case series -Ureterocele prolapse and urethral myoma 2