中樞性性早熟女孩治療後併發的尿道脫垂

陳浩瑋¹、邱意揚²、李經家 ¹、吳文正 ¹、陳妤甄¹

高雄醫學大學附設中和紀念醫院 泌尿部¹ 、高雄醫學大學²

Strangulated urethral prolapse occurring in a patient being treated for central precocious puberty

Hao-Wei Chen ¹, Yi-Yang Chiu ², Ching-Chia Li ¹, Wen-Jeng Wu ¹, Yu-Chen Chen ¹

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan¹

College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan²

Urethral prolapse is a rare condition mostly presented in preadolescent females. This condition probably occurred as result of the low levels of estrogen caused by continued treatment with leuprorelin. We hereby reported a rare case of developed urethral prolapse in central precocious puberty (CPP) patient.

This is a nine-year-old girl who came to our urology out-patient department due to a urethral mass noted for one month. She has underlying disease of CPP, which was diagnosed two years ago due to early breast buds development and advanced uterus and ovary size on pelvic sonography, which was compatible with 9 years old. Treatment of gonadotropin-releasing hormone (GnRH) agonist, leuprorelin, was started after a one-year follow-up with the dosing of 3.75mg subcutaneous every 4 weeks. No specific adverse effect of the drug was noticed during the course.

After the 11^th dose, a painless, soft, pinkish protruding urethral mass with regular border was observed for a month and the patient was brought to the urology out-patient department. Associated symptoms included dysuria and hematuria. Strangulated urethral prolapse was impressed. The protrusion was then treated surgically and leuprorelin injections were discontinued. There were no remarkable postoperative complications observed, and her symptoms were relieved after the surgery, without recurrence in the following 6 months.

Urethral prolapse is a rare benign condition in prepubertal girls. The typical manifestation of urethral prolapse is genital bleeding, mass, dysuria, and hematuria. It can be managed by surgical treatment. To the best of our knowledge, this is the first case of strangulated urethral prolapse reported to be occurred after the treatment for CPP. The low estrogen level suppressed by long-term GnRH agonist probably caused the late formation of urethral prolapse. We suggest discontinuing or closely monitoring CPP treatment to reduce the risk and the recurrence of urethral prolapse.