What Is Urethral Caruncle?

A urethral caruncle is the most common benign lesion of the female urethra. Most commonly seen in postmenopausal women, urethral caruncles are rare in men.

Lack of estrogen can cause changes to the organs of the genitourinary system (organs of the reproductive and urinary systems) that can lead to the development of a urethral caruncle.

Although 32% of cases are asymptomatic (without symptoms), a urethral caruncle can cause bleeding, discomfort, and urinary tract infections (UTIs). Treatment of the condition is usually conservative; however, an excision (removal of tissue) of the growth may be necessary in some cases.

This article will discuss the symptoms, causes, diagnosis, and treatment of a urethral caruncle.

What Is a Urethral Caruncle?

The urethra is the tube attached to the bottom of the bladder that drains urine from the body. The opening of the urethra is called the urethral meatus.

A urethral caruncle begins to form on the inside lip of the urethral meatus and is made of epithelial, squamous, and hyperplastic urothelial cells. The average age of onset, according to a 2012 review of literature on the topic, is about 68, and the benign (noncancerous) lesion is usually visible upon physical exam.

What Are Symptoms of Urethral Caruncles?

Most urethral caruncles are asymptomatic due to their small size. They typically measure less than 1 centimeter (cm). However, larger masses have been reported and can lead to pain and urinary retention (inability to empty the bladder). Other symptoms of urethral caruncle include:

• Dysuria (painful urination)
• Hematuria (blood in the urine)
• Pressure in the perineal area (the area between the genitals and anus)
• Urinary urgency and frequency
• Feeling or seeing a reddish strand or lump of tissue at the urethral meatus
  

Urinary tract infections can be a symptom of a urethral caruncle, especially when the mass prevents complete emptying of the bladder.

What Causes Urethral Caruncles?

Although the cause of urethral caruncles is not fully understood, hypoestrogenic (decreased estrogen level) is likely a significant contributing factor to the condition, especially in postmenopausal people.

Estrogen is responsible for the health and functionality of the female genitourinary system. During and after menopause, low estrogen levels can lead to genitourinary syndrome (GSM), which is characterized by the following:

• Genital dryness
• Tissue thinning
• Burning
• Urethral prolapse (the inner lining of the urethra sticks out of the opening)

In addition, urethral irritation and trauma have been identified as possible causes of urethral caruncles.

How Are Urethral Caruncles Diagnosed?

Most urethral caruncles are found incidentally (a chance occurrence) upon physical examination. However, people who experience bleeding or pain may be diagnosed with the condition during a focused examination of the perineal area. Diagnosis of a urethral caruncle can include:

• Seeing a pink or reddish growth coming out of the urethral meatus, usually at the 6 o'clock position
• Noticing a black or purple growth, indicating thrombosis (blood clotting) of the urethral caruncle
• Urethral prolapse, especially in postmenopausal women
• A biopsy (removing a sample tissue for testing in a lab) to determine the pathology of the lesion
• A cystoscopy (using a thin tube with a small camera attached) to visualize the urinary tract system
• Urinalysis (taking a sample of urine for testing in a lab) to rule out a urinary tract infection

Some cancerous lesions can mimic a urethral caruncle. Accounting for less than 1% of melanoma cases, primary malignant melanoma should be ruled out as this type of tumor can be mistaken for a urethral caruncle. Other cancers that should be considered are urethral lymphoma, urethral leiomyoma, and urethral carcinoma.

How Are Urethral Caruncles Treated

Treatment for urethral caruncles depends on their severity of symptoms and includes:

• Asymptomatic or mild symptoms: Soaking in a warm, shallow bath (sitz bath) and wearing undergarments that reduce irritation
• Moderate symptoms: Using topical estrogen cream and anti-inflammatory medication to improve the size and symptoms of the urethral caruncle
• A large mass or a great deal of pain: Excising (removing) the lesion (in some cases, the urethral caruncle can recur after surgical removal, especially in postmenopausal people)

Improvement in the size and symptoms of a urethral caruncle is often seen within six weeks of estrogen treatment, but it can take up to six months to completely resolve. Once estrogen is stopped, the urethral caruncle can recur or begin to grow again.

What Is the Prognosis of Urethral Caruncles?

Since urethral caruncles are benign lesions, the prognosis is good. Most urethral caruncles are asymptomatic and do not require treatment. If you have a urethral caruncle that begins to grow, bleed, or cause increased pain, you should be evaluated by a healthcare provider.

Summary

A urethral caruncle is a benign growth of tissue that starts on the inside of the urethral meatus. Most commonly seen in postmenopausal women, urethral caruncles are usually asymptomatic; however, bleeding and discomfort can occur.

Physical examination and biopsy of the lesion help with diagnosis. Treatment options for urethral caruncles range from warm sitz baths to topical estrogen. If you've been diagnosed with a urethral caruncle, tell a healthcare provider if the growth becomes larger, bleeds more often, or is painful.