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Health Inset > Diseases and Conditions > Urethral Caruncle

Urethral Caruncle

What is Urethral Caruncle?

It is a benign cutaneous condition. The term “Urethral Caruncle” actually refers to a granulomatous lesion of the distal urethra which is covered by transitional epithelial. It is mostly found in women who are experiencing menopause. It may also occur before pregnancy when it gets enlarged. These fleshy outgrowths are frequently associated with atrophic genital epithelium in elderly patients. At times, this condition becomes a source of infection, urethritis and chronic hematuria.

Urethral Caruncle Causes

These caruncles develop from several simultaneous processes. They are thought to occur from the prolapse of a distal segment of the urethra mucosa (known as the posterior lip of the urethra meatus). Caruncles are thought to be related to the deficiency of estrogen in the body. Abdominal pressure is also known to be another cause for Urethral Caruncle. Some patients develop this condition due to trauma to the area, or from inflammation that results from urinary tract infection. Caruncles may appear painful due to some chronic disease condition in the bladder or interstitial cystitis or several sexual transmitted diseases.

Urethral Caruncle Symptoms

Urethral Caruncles contain a core of blood vessels and loose connective tissue which is covered by hyperplastic transitional or squamous epithelium. A soft, smooth and red fleshy lesion or a red ring of urethral mucosa protrudes from the urethral orifice. This is the dense inflammatory infiltrate that results from excess irritation of the prolapsed segment of the mucosa. These may turn thrombose at times and their color might change into purple or black. The lesions may be malignant if they are firm to touch.

The major symptoms of this condition are:

  • Tenderness or irritation
  • Presence of blood in the urine
  • Bloody spotting with mild trauma
  • Difficulty in urination along with painful feeling
  • Painful micturition or dyuspareunia
  • Pedunculated red mass which is tender to touch

The primary sign of this condition is a thin, reddish membrane which protrudes from one part of the urethral opening. Bleeding is the other sign which is sometimes seen in this condition.

Urethral Caruncle Diagnosis

A differential diagnosis is done for Urethral Caruncle as its symptoms are similar to that of urethral prolapsed which occurs in younger women. This usually happens when a woman is about to experience menopause. The patient is also diagnosed for disorders like:

  • Melanoma
  • Tuberculosis
  • Intestinal polyp-like lesions
  • Non-Hodgkin’s lymphoma

These may turn into urethral caruncle, get enlarged and start to bleed like urethral carcinoma. A carcinoma can also appear as a caruncle.

If the diagnosis is not clear and there is a presence of Dysuria, a midstream specimen of urine will be sent for culture to check if there is any urinary tract infection. If there is uncertainty yet, cystoscopy and biopsy may be done.

Urethral Caruncle Treatment

In some rare cases the caruncle may not heal on its own and may require treatment. Treatment for the condition is usually symptomatic.

Medical Therapy

Anti-inflammatory medications and estrogen creams can help reduce the pain as also the swelling in the urethra region. A warm salt bath can also help reduce the swelling.

Surgical Therapy

Patients in whom diagnosis is not clear or those diagnosed with severe form of urethra caruncle may have to undergo surgical intervention. In certain cases, thus, the fleshy lump needs to be removed under local anesthesia. Surgical excision may be required if the symptoms continue to show. Preoperative preparation includes standard vaginal preparation and antibiotics.

Removal of the fleshy lump is carried out in the following steps:

  • Firstly, the cystourethroscopy will be done to make sure that there is no bladder or urethral abnormalities.
  • A Foley catheter is placed.
  • Stay-sutures are used in the epithelium to prevent the occurrence of mucosal retraction and meatal stenosis.
  • The lesion is excised.
  • The edges are sewed with 3-0 or 4-0 absorbable sutures which may be chromic or polyglactin.

Another technique involves the ligation of the base of the caruncle which makes it slough off after 1-2 weeks. This method does not require any anesthesia or analgesics. The Foley catheter is left in place for 1-2 days to allow the urethral mucosa to heal.

Urethral Caruncle is not fatal. A patient successfully recovers after proper treatment.

Urethral Caruncle Pictures

Here are some pictures that will help you understand this condition.

Picture of Urethral Caruncle

Picture 1 - Urethral Caruncle

Image of Urethral Caruncle

Picture 2 - Urethral Caruncle Image

References:

http://en.wikipedia.org/wiki/Urethral_caruncle

http://www.patient.co.uk/doctor/Urethral-Caruncle.htm

http://www.uptodate.com/contents/urethral-caruncle

http://www.wisegeek.com/what-is-a-urethral-caruncle.htm

By   Last updated November 10th, 2012

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