Urethral caruncles are the most common urethral lesion in postmenopausal women.
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Epidemiology
The lesion accounts for >90% of urethral masses in postmenopausal women 2.
Clinical presentation
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.
Pathology
Etiology
The etiology has been hypothesized to involve chronic irritation in the setting of urethral prolapse and mucosal atrophy due to hypoestrogenic state 1,2.
Microscopic appearance
Histologically, the lesion consists of hyperplastic squamous and urothelial epithelium, fibrosis, and inflammation 1,2.
Radiographic appearance
MRI
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
Treatment and prognosis
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.
Differential diagnosis
Consider 2: