Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. The initial diagnosis, made by the referring pediatrician or emergency physician, was correct in only five girls (21%). Twenty children presented with urogenital bleeding. Operative correction was employed as initial treatment in 16 girls, with one recurrence. The remaining eight children were treated nonoperatively. Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.