Urethral caruncle, Symptoms and Treatment of Urethral caruncle
Urethral caruncles are benign, distal urethral lesions most commonly found in postmenopausal females. Urethral caruncle is a reddened area involving the posterior margin of the urethral orifice. Because they sometimes look like urethral carcinoma, they may be alarming to the untrained eye. Urethral caruncles are common in elderly females but rare in perimenopausal women.
Causes of Urethral caruncle
Urethral caruncle is caused by redundancy of the mucosa combined with laxity of the periurethral fascia, and it may be aggravated by an increase in intra-abdominal pressure and a relative lack of estrogen.
Symptoms of Urethral caruncle
Patients may be asymptomatic or may present with urethral bleeding, urinary urgency or frequency, or dysuria. Unlike a neoplasm, which generally is firm and nontender, a caruncle is soft and may be tender.
- Painful micturition or dyuspareunia.
- bloody spotting with mild trauma
- Sassile or pedunculated red mass that is tender to touch.
Treatment and Cure of Urethral caruncle
Medical therapy: Treat most patients conservatively with warm sitz baths. Topical estrogen creams and topical anti-inflammatory drugs may also be useful.
Surgical therapy: Reserve surgical intervention for patients with larger symptomatic lesions and for those with uncertain diagnoses. Tumors are found in approximately 2% of urethral caruncles.
Preoperative details: Standard vaginal preparation and antibiotics are recommended.
Intraoperative details: Removal is a simple operation and involves the following steps:
- First, perform a cystourethroscopy to rule out bladder and urethral abnormalities. Many urologists perform a cystoscopy in the office, upon initial patient presentation, to rule out other pathologies (eg, carcinoma, diverticulum, abscess).
- Place a Foley catheter.
- Use stay-sutures in the epithelium to prevent mucosal retraction and meatal stenosis.
- Excise the lesion.
- Oversew the edges with 3-0 or 4-0 chromic sutures.
Synonyms and related keywords: urethral lesions, caruncula, carunculae, urethral diverticulum, urethral carcinoma, periurethral gland abscess, dysuria, distal urethral prolapse, estrogen deficiency, epithelium, polymorphous inflammatory infiltrate