Urethral caruncle

Last revised by Subhan Iqbal on 7 Sep 2020

Urethral caruncles are the most common urethral lesion in postmenopausal women.

The lesion accounts for >90% of urethral masses in postmenopausal women 2.

Most women are asymptomatic, but caruncles can cause pain, dysuria or bleeding 4. On physical examination, there is a protrusion of fleshy tissue from the posterior margin of the external urethral meatus.

The etiology has been hypothesized to involve chronic irritation in the setting of urethral prolapse and mucosal atrophy due to hypoestrogenic state 1,2.

Histologically, the lesion consists of hyperplastic squamous and urothelial epithelium, fibrosis, and inflammation 1,2.

There is soft tissue thickening at the external urethral meatus, measuring 5-20 mm in size, usually anteriorly displacing the urethra, with the following signal characteristics 1,2:

  • T2: hyperintense
  • T1: hypointense

The treatment includes topical estrogen cream. A smaller percentage of lesions (<3%) are associated with carcinoma. If the lesion does not respond, surgical excision can be considered to exclude malignancy 4.

Consider 2:

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