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Extend medical Tx to 6 weeks in pediatric urethral prolapse. (Chart Review of 31 Girls).
MIAMI BEACH -- Medical treatment of pediatric urethral prolapse is much more successful if it is prolonged beyond the traditional 2 weeks because it can significantly reduce the need for surgical intervention, Dr. Victoria Davis reported.
According to the textbooks, this condition should be treated medically for up to 2 weeks and then surgery should be performed if it has not resolved. "But we found that if you extend the treatment longer you can get a much better success rate arid avoid the potential complications of surgery" said Dr. Davis, acting chief of pediatric and adolescent gynecology at the Hospital for Sick Children in Toronto.
Dr. Davis described her chart review of 31 girls with urethral prolapse at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
The girls were aged between 20 months and 11 years and were treated twice a day with topical estrogen cream for up to 6 weeks. She reported a 65% success rate and a medical failure/surgery rate of 35%.
"This compares to studies in the literature that report a surgery rate of between 67% and 86%, and a 7% rate of surgical complications such as bleeding and urethral stenosis," Dr. Davis said in an interview. Patients with urethral prolapse should be evaluated every 2 weeks and stay on topical estrogen cream for up to 6 weeks if they are doing well, she recommended.
"It depends on how bad the prolapse is and how much it's bothering the child. They usually have a mucousy discharge, which causes irritation. If there is too much irritation, it is likely to start bleeding," she ...
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