Urethral Caruncle Surgery India
Urethral caruncle is a term that describes a benign polypoidal growth at the urethral meatus. It is most commonly observed in postmenopausal women. Certain tumors can masquerade as a urethral caruncle. The caruncle may be asymptomatic or it can present with dysuria and bloody discharge. The diagnosis is made by microscopic examination, while treatment includes excision in symptomatic patients.
The majority of patients are asymptomatic, and the diagnosis of urethral caruncle is incidental either during a physical examination or during invasive diagnostic procedures. Patients most often complain of painful and frequent urination, with or without hematuria. During the physical examination, patients frequently report pain during urethral palpation and the lesion can be diagnosed during inspection and palpation because it often protrudes from the external urethral meatus. This lesion may be significantly debilitating for patients and cause significant distress.
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.
Carcinoma of the urethra.
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.
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.
Primary carcinomas arising from a urethral caruncle are rare but are known to occur.