The female urethra is short and is fixed to the pelvic floor, so mobility of the urethra is limited except for pelvic floor weakness, which causes urethral hypermobility or cystocele during increased intra-abdominal pressure. Urethral prolapse is uncommon and seen in most cases as a circumferential eversion of the urethral mucosa through the external urethral meatus. Prolapse of the anterior urethral wall presenting as a large vulval mass is even most rare.

We herein report a 73-year-old woman, gravida 6 para 6, presented to our OPD complaining of a mass protruding from the vulva and blood-tinged toilet paper after wiping after voiding for several weeks. Mild stress urinary incontinence was also noted. On physical examination, an erythematous tumor-like lesion with smooth surface, about 2.3 cm in diameter, was noted on the vestibule at the original site of the external urethral orifice. The real external urethral orifice was pushed downward and was underneath the mass. There was no anterior vaginal wall prolapse. Excretory urogram showed normal bladder and kidneys and minimal postvoid residual urine. Cystourethroscopy revealed prolapse of the anterior wall of the urethra. The patient was treated by wedge resection of the most protruding portion of the mass, and the anterior urethral wall was reduced back through sequential multi-layered plications of the overlying soft tissues. Finally an indwelling urethral catheter was inserted into the bladder for drainage. Histopathological study showed the lining epithelium was stratified squamous epithelium with parakeratosis. The patient recovered uneventfully and after five months of follow-up the vulva looked normal and no more complaint of vulval discomfort or stress urinary incontinence.