Urethral Caruncle Treatment & Management

Author: Kamran P Sajadi, MD; Chief Editor: Edward David Kim, MD, FACS more...

Updated: Aug 15, 2011

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Medical Therapy
Surgical Therapy
Preoperative Details
Intraoperative Details
Postoperative Details
Follow-up
Complications
Outcome and Prognosis
Future and Controversies
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Medical Therapy

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.

Surgical Therapy

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.

Preoperative Details

Standard vaginal preparation and preoperative 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 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.^[10]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 is required.

Complications

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.

Contributor Information and Disclosures

Author

Kamran P Sajadi, MD Assistant Professor, Urology, Oregon Health & Science University

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.

Specialty Editor Board

Allen Donald Seftel MD, Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel is a member of the following medical societies: American Urological 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; endo Consulting fee Consulting; nature publishing journal editor

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

J Stuart Wolf Jr, MD, FACS The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

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: Nothing to disclose.

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, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

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

This image shows marked vascular engorgement and a polymorphous inflammatory infiltrate in the stroma. Surface epithelium is benign. Courtesy of G.T. MacLennan, MD.

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