eMedicine Specialties > Urology > Common Problems of the Urethra

Urethral Caruncle: Treatment

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

Treatment

Medical Therapy

Most urethral caruncles can be treated conservatively with warm sitz baths. Topical estrogen creams and topical anti-inflammatory drugs may also be useful. Unfortunately, data on the efficacy of conservative management are lacking in the literature.

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. Therefore, if there is any doubt in the diagnosis, excision is recommended.

Preoperative Details

Standard vaginal preparation and antibiotics are recommended.

Intraoperative Details

Excision is usually an outpatient 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.
  • Park and Cho have described an alternative technique for removal of a urethral caruncle, whereby the base of the caruncle is ligated, allowing it to slough off after 1-2 weeks.7 Their technique requires neither anesthesia nor analgesics.

Postoperative Details

A Foley catheter may be left in place for 1-2 days to allow for appropriate healing of the urethral mucosa.

Follow-up

If the lesion is benign, no special follow-up arrangement other than a routine postoperative visit is required.

Complications

If the epithelium is not everted adequately with the stay-stitch, meatal retraction and stenosis may occur.

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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