Urethral Caruncle

Definition/diagnostic criteria Urethral caruncles are benign, fleshy outgrowths located at the posterior lip of the urethral meatus. They are considered the most common benign tumours of the female urethra. Typically, they present as small, red, and painless lesions, although larger caruncles can be symptomatic. Diagnosis is primarily clinical.

Epidemiology Urethral caruncles predominantly affect postmenopausal women. This condition is rare in males. The exact prevalence is not well documented, partly due to the asymptomatic nature of many caruncles.

Diagnosis

Clinical features Patients with urethral caruncle may present with symptoms such as dysuria, urinary frequency, urgency, haematuria, or even asymptomatic visible lesions. On examination, caruncles appear as reddish, pedunculated lesions at the posterior part of the urethral meatus. They may vary in size and are usually tender when inflamed or infected.

Investigations Diagnosis is primarily clinical. However, in atypical cases or when malignancy is suspected, further investigations may be warranted. Differential diagnosis includes urethral prolapse, malignancy, or Skene’s duct cysts. Biopsy is recommended in cases where there is suspicion of malignancy, atypical appearance, or lack of response to initial treatment. Urinalysis may be conducted to rule out urinary tract infection.

Treatment Treatment is guided by the severity of symptoms and the presence of complications. Asymptomatic caruncles may require no treatment apart from reassurance and observation.

For symptomatic caruncles, conservative management includes mild steroid cream, and topical oestrogen cream in postmenopausal women.

If conservative measures fail or the lesion causes discomfort, surgical excision may be considered. Excision is typically reserved for larger, symptomatic caruncles or when malignancy cannot be excluded. Antibiotics are prescribed if there is evidence of infection.

Prognosis Most caruncles are benign and can be effectively managed with conservative treatment or surgical excision. However, it is crucial to conduct a follow-up, especially in cases where malignancy cannot be initially excluded.