Urethral Caruncle

Updated: Nov 02, 2020
  • Author: Kamran P Sajadi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Overview

Practice Essentials

Urethral caruncles are benign, distal urethral lesions that are most commonly found in postmenopausal women, although rare cases have been reported in girls, and a case of urethral caruncle has also been described in a male. [1, 2, 3] Additionally, urethral caruncles have been reported to occur rarely in premenopausal women and may enlarge during pregnancy. Urethral polyps are the pediatric equivalent of urethral caruncles and manifest in a similar fashion.\Urethral caruncles resemble various urethral lesions, including carcinoma. The differential diagnoses of urethral caruncle include the following:

Most urethral caruncles can be treated conservatively with warm sitz baths and vaginal estrogen replacement. Surgical intervention may be indicated for patients with larger symptomatic lesions and for those with uncertain diagnoses. Possible indications for excisional biopsy include the following:

  • Induration
  • Failure to respond to conservative therapy
  • Atypical appearance
  • Growth over time
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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 cm or more in diameter.

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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.

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Pathophysiology

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

 

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Epidemiology

Urethral caruncles are common in elderly postmenopausal women but may rarely develop in girls or premenopausal or perimenopausal women. [5, 3]

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Prognosis

The prognosis is excellent if pathology confirms urethral caruncle as the diagnosis.

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