eMedicine Specialties > Urology > Common Problems of the Urethra

Urethral Caruncle

Author: Kamran P Sajadi, MD, Staff Physician, Glickman Urological and Kidney Institute, Cleveland Clinic
Coauthor(s): Ann Y Becker, MD, Assistant Professor, Section of Urology, Medical College of Georgia; Scott Rutchik, MD, Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: Oct 30, 2009

Introduction

Urethral caruncles are benign, distal urethral lesions that are most commonly found in postmenopausal women. Recently, a case of urethral caruncle has also been described in a male.1 Urethral caruncles resemble various urethral lesions, including carcinoma. The differential diagnoses of urethral caruncle include urethral diverticulum, urethral prolapse, urethral carcinoma, and periurethral gland abscesses.

Problem

Urethral caruncles, which often originate from the posterior lip of the urethra, may be described as fleshy outgrowths of distal urethral mucosa. They are usually small but can grow to 1-2 cm in diameter.

Frequency

Urethral caruncles are common in elderly postmenopausal women but are rare in premenopausal or perimenopausal women. Urethral prolapse is similar in appearance but is more common in preadolescent girls. Urethral prolapse may also occur in postmenopausal females, though less commonly, and may play a role in the pathogenesis of caruncles.

Etiology

Urethral caruncles may develop from several simultaneous processes, as discussed in the Pathophysiology section.

Pathophysiology

The first step in the development of a urethral caruncle is likely distal urethral prolapse caused by estrogen deficiency. Chronic irritation contributes to the growth, hemorrhage, and necrosis of the lesion.

Cases of urethral melanoma,2 tuberculosis,3,4 intestinal ectopia, and lymphoma5,6 masquerading as urethral caruncle have been reported; however, reports of these associations are rare. Additionally, urethral caruncles have been reported to occur rarely in the premenopausal patient and may enlarge during pregnancy. Urethral polyps are the pediatric equivalent of urethral caruncles and manifest in a similar fashion.

Presentation

Most urethral caruncles are asymptomatic and are incidentally noted on pelvic examination; however, some may be painful, and others may be associated with dysuria. They most often appear clinically as a pink or reddish exophytic lesion at the urethral meatus; in rare cases, they are purple or black secondary to thrombosis. Many individuals with a urethral caruncle present with bleeding or blood on the undergarments. Some caruncular lesions may resemble urethral carcinoma.

Indications

Conservative therapy (ie, warm sitz baths, topical estrogen creams, topical anti-inflammatory drugs) is appropriate in most patients. Surgical intervention should be reserved for patients with larger symptomatic lesions, for those in whom conservative therapy fails to elicit a response, and for those with uncertain diagnoses.

Relevant Anatomy

The female urethra is a 4- to 5-cm tubular structure. It is normally lined by nonkeratinized stratified squamous epithelium distally and transitional epithelium proximally. Outer layers have a complex network of smooth muscle fibers and vascular structures.

Contraindications

Surgical therapy should be reserved for women with larger symptomatic lesions and for women with uncertain diagnoses.

More on Urethral Caruncle

Overview: Urethral Caruncle
Workup: Urethral Caruncle
Treatment: Urethral Caruncle
Follow-up: Urethral Caruncle
Multimedia: Urethral Caruncle
References
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References

  1. Karthikeyan K, Kaviarasan PK, Thappa DM. Urethral caruncle in a male: a case report. J Eur Acad Dermatol Venereol. Jan 2002;16(1):72-3. [Medline].

  2. Nakamoto T, Inoue Y, Ueki T, Niimi N, Iwasaki Y. Primary amelanotic malignant melanoma of the female urethra. Int J Urol. Feb 2007;14(2):153-5. [Medline].

  3. Indudhara R, Vaidyanathan S, Radotra BD. Urethral tuberculosis. Urol Int. 1992;48(4):436-8. [Medline].

  4. Singh I, Hemal AK. Primary urethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity!. Int Urol Nephrol. 2002;34(1):101-3. [Medline].

  5. Khatib RA, Khalil AM, Tawil AN, Shamseddine AI, Kaspar HG, Suidan FJ. Non-Hodgkin's lymphoma presenting as a urethral caruncle. Gynecol Oncol. Sep 1993;50(3):389-93. [Medline].

  6. Young RH, Oliva E, Garcia JA, Bhan AK, Clement PB. Urethral caruncle with atypical stromal cells simulating lymphoma or sarcoma--a distinctive pseudoneoplastic lesion of females. A report of six cases. Am J Surg Pathol. Oct 1996;20(10):1190-5. [Medline].

  7. Park DS, Cho TW. Simple solution for urethral caruncle. J Urol. Nov 2004;172(5 Pt 1):1884-5. [Medline].

  8. Martin FM, Rowland RG. Urologic malignancies in pregnancy. Urol Clin North Am. Feb 2007;34(1):53-9. [Medline].

  9. Petersen RO, Stein BS. Genitourinary Pathology. In: Practice of Urology. New York, NY: Norton Medical Books; 1993:48.

  10. Rovner ES. Bladder and urethral diverticula. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh Urology. Vol 3. 9th ed. Philadelphia, PA: WB Saunders Co; 2007:2361-72.

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Further Reading

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Keywords

urethral caruncle, urethral lesions, caruncula, carunculae, urethral diverticulum, urethral carcinoma, periurethral gland abscess, dysuria, distal urethral prolapse, estrogen deficiency, epithelium, polymorphous inflammatory infiltrate

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Contributor Information and Disclosures

Author

Kamran P Sajadi, MD, Staff Physician, Glickman Urological and Kidney Institute, Cleveland Clinic
Kamran P Sajadi, MD is a member of the following medical societies: American Urological Association, Endourological Society, and National Association for Continence
Disclosure: Nothing to disclose.

Coauthor(s)

Ann Y Becker, MD, Assistant Professor, Section of Urology, Medical College of Georgia
Ann Y Becker, MD is a member of the following medical societies: American Medical Women's Association, American Urological Association, and Society of Women in Urology
Disclosure: Nothing to disclose.

Scott Rutchik, MD, Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine
Scott Rutchik, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Allen Donald Seftel, MD, Professor, Department of Urology, Case School of Medicine
Allen Donald Seftel, MD is a member of the following medical societies: Ohio State Medical Association
Disclosure: lilly Consulting fee Consulting; sanofi-aventis Consulting fee Consulting; auxilium Consulting fee Consulting; solvay Consulting fee Consulting; plethora Grant/research funds clinical trial; indevus Consulting fee Consulting; nature publishing  journal editor

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Jeffrey Noble, MD, Consulting Staff, Urologic Institute, Cleveland Clinic Foundation
Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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