LAUSR

9 Thrombosed postpartum urethral prolapse K. Elmezzi, H. Matthews, G. Stone, J. Fischer, D. Gruber Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD OBJECTIVE: Urethral prolapse is a rare occurrence with a reported incidence of approximately 1:3000. Although its etiology is unclear, proposed causes include lack of estrogen and dysfunctional periurethral tissue. Few reports have been described in reproductive age women, with most affected being in the pre-pubertal and postmenopausal period. DESCRIPTION: This is a video of a 29-year-old woman who presented to the Urogynecology clinic five weeks after an uncomplicated vaginal delivery with a painful peri-urethral mass consistent with thrombosis of the prolapsed urethral tissue. Initial conservative management with an indwelling urethral catheter and topical estrogen did not relieve her symptoms. This video shows the surgical technique used to excise the thrombosed tissue in the operating room. The procedure was uncomplicated and at postoperative follow-up, she reported complete resolution of her symptoms. CONCLUSION: Patients with urethral prolapse most commonly present with vaginal bleeding and lower urinary tract symptoms. In contrast, this patient likely suffered trauma to the urethra during vaginal delivery, resulting in thrombosis. The usual conservative treatments for urethral prolapse were ineffective and she underwent surgical management with complete resolution of her symptoms. Urethral thrombosis should be considered when evaluating premenopausal women with a painful peri-urethral mass. Treatment should be tailored to the patient and surgical excision considered after failure of conservative management.