- Leslie M Rickey, MD, MPH
Leslie M Rickey, MD, MPH
- Associate Professor
- Yale School of Medicine
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Linda Brubaker, MD, FACOG
Linda Brubaker, MD, FACOG
- Section Editor — Female Pelvic Medicine and Reconstructive Surgery
- Health Sciences Clinical Professor
- University of California, San Diego
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
A urethral caruncle is a benign fleshy outgrowth at the urethral meatus. It is the most common lesion of the female urethra, occurring primarily in postmenopausal women.
The terms urethral caruncle, urethral prolapse, and urethral polyp are sometimes used interchangeably. Technically, urethral prolapse refers to mucosa that is circumferentially everted at the meatus, whereas urethral caruncle refers to eversion of only a portion of the distal urethra, often at the posterior edge.
The pathogenesis of urethral caruncles is not well understood. A distal segment of the urethral mucosa, most commonly the posterior lip of the urethral meatus, prolapses to form the caruncle. Estrogen deficiency after menopause results in atrophy of the uroepithelium, which appears to be a predisposing factor. Chronic inflammation of the exposed, prolapsed urethral mucosa may lead to enlargement, bleeding, and necrosis.
Histologically, urethral caruncles contain a core of blood vessels and loose connective tissue covered by hyperplastic urothelial and squamous epithelium [1,2]. Chronic irritation of the prolapsed segment of mucosa results in a dense inflammatory infiltrate. The stromal component may be associated with variable degrees of edema, vascularity, red blood cell extravasation, and fibrosis; dilated blood vessels may contain organizing thrombus . Urethral caruncles are subclassified as granulomatous, papillomatous, or angiomatous .
Patient presentation — Most patients are postmenopausal, with occasional occurrences in premenopausal women and prepubertal girls [3,5-7]. Affected males have been described in single case reports [5,8].
- Kaufman RH. Benign diseases of the vulva and vagina, 4th ed, Mosby, St. Louis 1994.
- PALMER JK, EMMETT JL, McDONALD JR. Urethral caruncle. Surg Gynecol Obstet 1948; 87:611.
- Conces MR, Williamson SR, Montironi R, et al. Urethral caruncle: clinicopathologic features of 41 cases. Hum Pathol 2012; 43:1400.
- Becker LE. Urethral caruncle: a herald lesion for distal urethral stenosis? J Natl Med Assoc 1975; 67:228.
- Karthikeyan K, Kaviarasan PK, Thappa DM. Urethral caruncle in a male: a case report. J Eur Acad Dermatol Venereol 2002; 16:72.
- Türkeri L, Simşek F, Akdaş A. Urethral caruncle in an unusual location occurring in prepubertal girl. Eur Urol 1989; 16:153.
- Kim KK, Sin DY, Park HW. Urethral caruncle occurring in a young girl--a case report. J Korean Med Sci 1993; 8:160.
- Sriprasad S, Kooiman GG, Hopster D, Muir GH. Urethral caruncle in a man. BJU Int 2003; 92 Suppl 3:e68.
- Ozkurkcugil C, Ozkan L, Tarcan T. The effect of asymptomatic urethral caruncle on micturition in women with urinary incontinence. Korean J Urol 2010; 51:257.
- MARSHALL FC, USON AC, MELICOW MM. Neoplasma and caruncles of the female urethra. Surg Gynecol Obstet 1960; 110:723.
- Cimentepe E, Bayrak O, Unsal A, et al. Urethral adenocarcinoma mimicking urethral caruncle. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:96.
- Atalay AC, Karaman MI, Basak T, et al. Non-Hodgkin's lymphoma of the female urethra presenting as a caruncle. Int Urol Nephrol 1998; 30:609.
- Nakamoto T, Inoue Y, Ueki T, et al. Primary amelanotic malignant melanoma of the female urethra. Int J Urol 2007; 14:153.
- Omar A, Thomas A, Thompson I. Primary urethral transitional cell carcinoma presenting as a urethral caruncle. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:1227.
- Khatib RA, Khalil AM, Tawil AN, et al. Non-Hodgkin's lymphoma presenting as a urethral caruncle. Gynecol Oncol 1993; 50:389.
- Hammadeh MY, Thomas K, Philp T. Urethral caruncle: an unusual presentation of ovarian tumour. Gynecol Obstet Invest 1996; 42:279.
- Singh I, Hemal AK. Primary urethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity! Int Urol Nephrol 2002; 34:101.
- Järvi OH, Marin S. Intestinal mucosal heterotopia of an urethral caruncle. Acta Pathol Microbiol Immunol Scand A 1982; 90:213.
- Arnold SJ, Goode R, Ginsburg A. Photostudies of urethral varices "hemorrhoids": a forgotten lesion. Urology 1978; 11:19.
- North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause 2007; 14:355.
- Rudin JE, Geldt VG, Alecseev EB. Prolapse of urethral mucosa in white female children: experience with 58 cases. J Pediatr Surg 1997; 32:423.
- CLINICAL MANIFESTATIONS
- Patient presentation
- Findings on physical examination
- Differential diagnosis
- Asymptomatic lesions
- Symptomatic lesions
- - Initial approach
- - Large or persistent lesions
- - Recurrrent lesions
- SUMMARY AND RECOMMENDATIONS