Urethral Caruncle

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

A urethral caruncle is a benign polypoid mass of the urethral meatus, most commonly found in postmenopausal women.

It is uncommon, but is almost exclusively found in postmenopausal women.[1]A single case has been reported in a man.[2]

Aetiology is not well understood. Lack of oestrogen may be a factor. Viral, autoimmune and inflammatory proliferative factors do not appear to be implicated.[3]

History[1]

Often there are no symptoms but sometimes they are painful. There may be dysuria and occasionally they may bleed. Urethral caruncles do not appear to have a detrimental effect on micturition or continence.[4] Urethral caruncles are an unusual cause of postmenopausal bleeding.

Examination

There is a soft smooth red fleshy lesion or red ring of urethral mucosa protruding through the urethral orifice. It may appear to be polypoid (sessile or pedunculated). They may (rarely) thrombose and turn purple or black. Urethral caruncles tend to be soft and may be tender whilst malignancy is usually firm and not tender.

The main differential diagnosis is urethral mucosal prolapse.

The following conditions have been reported to present masquerading as a urethral caruncle:

  • Malignant melanoma of the urethra.[5, 6]
  • Carcinoma of the urethra.[7, 8, 9]
  • Tuberculosis.[10]
  • Lymphoma.
  • Urethral leiomyoma.[11]
  • Intestinal ectopia.

If the diagnosis is clear there is no need for further investigation. If dysuria is present, a midstream specimen of urine (MSU) should be sent for microscopy and culture to exclude urinary tract infection. Only if there is uncertainty about diagnosis are cystoscopy and biopsy indicated.

  • If the diagnosis is clear and the lesion is asymptomatic then no further action is required.
  • In the elderly patient with oestrogen deficiency and symptoms, oestrogen cream may be useful.
  • Warm salt baths and anti-inflammatory creams have been used, although some evidence suggests they lack efficacy.[1]
  • If symptoms persist, caruncles can be removed using cauterisation, laser vaporisation, excision or even ligation.[12]Cryotherapy or surgical excision may also be used.
  • Surgical intervention is indicated only if the lesions are large or the diagnosis is uncertain.
  • Primary carcinomas arising from a urethral caruncle are rare but are known to occur.[13]

If the diagnosis is correct, there is no associated mortality. Symptoms (if any) should subside with treatment.

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Original Author:
Dr Laurence Knott
Current Version:
Dr Mary Harding
Peer Reviewer:
Prof Cathy Jackson
Document ID:
2901 (v22)
Last Checked:
14 August 2014
Next Review:
13 August 2019

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.