Urethral Caruncle Treatment & Management
- Author: Kamran P Sajadi, MD; Chief Editor: Edward David Kim, MD, FACS more...
Most urethral caruncles can be treated conservatively with warm sitz baths and vaginal estrogen replacement. Topical anti-inflammatory drugs may also be useful. Unfortunately, data on the efficacy of conservative management are lacking in the literature.
Reserve surgical intervention for patients with larger symptomatic lesions and for those with uncertain diagnoses. Induration, failure to respond to conservative therapy, atypical appearance, or growth over time may be indications for excisional biopsy. Tumors are found in approximately 2% of urethral caruncles.
Standard vaginal preparation and preoperative antibiotics are recommended.
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 absorbable sutures (chromic or polyglactin).
- 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. Their technique requires neither anesthesia nor analgesics.
A Foley catheter may be left in place for 1-2 days to allow for appropriate healing of the urethral mucosa.
If the lesion is benign, no special follow-up is required.
If the epithelium is not everted adequately with the stay-stitch, meatal retraction and stenosis may occur.
Outcome and Prognosis
The prognosis is excellent if pathology confirms urethral caruncle as the diagnosis.
Future and Controversies
Urethral caruncle management is straightforward. As the etiology of these lesions is better elucidated, improvements in medical therapies may obviate surgery.
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