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Urethral caruncle

Medical Professionals

Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our health articles more useful.

A urethral caruncle is a benign fleshy outgrowth at the urethral meatus that occurs mainly at posterior lip of urethra1 .

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It is uncommon, but is most commonly found in postmenopausal women12 .


Aetiology is not well understood. Lack of oestrogen may be a factor. Viral, autoimmune and inflammatory proliferative factors do not appear to be implicated3 .

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Urethral caruncles are typically asymptomatic and are mostly reported as incidental findings during pelvic examination. Common symptoms include bleeding, haematuria, pain, dysuria or a lump1 .


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 continence4 . Urethral caruncles are an unusual cause of postmenopausal bleeding.


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.

Differential diagnosis

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 urethra5 .

  • Carcinoma of the urethra67 .

  • Urethral tuberculosis.

  • Lymphoma.

  • Urethral leiomyoma8 .

  • Intestinal ectopia.

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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. Management options include:

  • In perimenopausal and postmenopausal women, oestrogen cream may be useful9 .

  • Warm salt baths and anti-inflammatory creams have been used, although some evidence suggests they lack efficacy2 .

  • If symptoms persist, caruncles can be removed using cauterisation, laser vaporisation, excision or even ligation. Cryotherapy or surgical excision may also be used.

  • Surgical intervention is indicated only if the lesions are large or the diagnosis is uncertain.


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

Primary carcinomas arising from a urethral caruncle are rare but are known to occur10 .

Further reading and references

  1. Verma V, Pradhan A; Management of urethral caruncle - A systematic review of the current literature. Eur J Obstet Gynecol Reprod Biol. 2020 May;248:5-8. doi: 10.1016/j.ejogrb.2020.03.001. Epub 2020 Mar 6.
  2. Conces MR, Williamson SR, Montironi R, et al; Urethral caruncle: clinicopathologic features of 41 cases. Hum Pathol. 2012 Sep;43(9):1400-4. doi: 10.1016/j.humpath.2011.10.015. Epub 2012 Mar 6.
  3. Williamson SR, Scarpelli M, Lopez-Beltran A, et al; Urethral caruncle: a lesion related to IgG4-associated sclerosing disease? J Clin Pathol. 2013 Jul;66(7):559-62. doi: 10.1136/jclinpath-2012-201218. Epub 2012 Nov 30.
  4. Ozkurkcugil C, Ozkan L, Tarcan T; The effect of asymptomatic urethral caruncle on micturition in women with urinary incontinence. Korean J Urol. 2010 Apr;51(4):257-9. doi: 10.4111/kju.2010.51.4.257. Epub 2010 Apr 20.
  5. Safadi A, Schwalb S, Ben-Shachar I, et al; Primary malignant urethral melanoma resembling a urethral caruncle. Urol Case Rep. 2017 Sep 9;15:28-29. doi: 10.1016/j.eucr.2017.08.004. eCollection 2017 Nov.
  6. Shim JS, Oh MM, Lee JG, et al; Anterior urethrectomy for primary carcinoma of the female urethra mimicking a urethral caruncle. Int Neurourol J. 2013 Dec;17(4):197-9. doi: 10.5213/inj.2013.17.4.197. Epub 2013 Dec 31.
  7. Tatemichi Y, Oikawa H, Maesawa C, et al; Detection of human papillomavirus in a urothelial carcinoma mimicking urethral caruncle. Int J Urol. 2010 Feb;17(2):189-91. doi: 10.1111/j.1442-2042.2009.02434.x.
  8. Saroha V, Dhingra KK, Gupta P, et al; Urethral leiomyoma mimicking a caruncle. Taiwan J Obstet Gynecol. 2010 Dec;49(4):523-4. doi: 10.1016/S1028-4559(10)60110-6.
  9. Balai M, Gupta LK, Kumari A; Urethral caruncle in a perimenopausal female: Dramatic response to topical estrogen cream. Indian J Urol. 2018 Oct-Dec;34(4):308-309. doi: 10.4103/iju.IJU_200_18.
  10. Kaneko G, Nishimoto K, Ogata K, et al; A case of intraepithelial squamous cell carcinoma arising from urethral caruncle. Can Urol Assoc J. 2011 Feb;5(1):E14-6. doi: 10.5489/cuaj.10027.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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