How is a urethral caruncle or similar urethral growth removed?

Urethral Caruncle Removal Techniques

Simple excision is the most common and effective surgical treatment for urethral caruncles, especially for symptomatic cases or those that fail conservative management. 1

What is a Urethral Caruncle?

• A urethral caruncle is a benign fleshy outgrowth at the urethral meatus, most commonly occurring at the posterior lip of the urethra in postmenopausal women 1
• These growths can be asymptomatic or present with bleeding, hematuria, pain, dysuria, or as a visible lump 1
• In rare cases, they can cause acute urinary retention 2

Management Options

Conservative Management

• For asymptomatic or minimally symptomatic cases, observation may be appropriate 1
• Topical estrogen therapy may be beneficial, especially in postmenopausal women 2
• Conservative management evidence is limited in current literature 1

Surgical Management

Simple Excision

• Simple surgical excision is the most common treatment method for symptomatic urethral caruncles 1
• The procedure is typically performed under local or spinal anesthesia 2
• Excision allows for pathological evaluation of the tissue to rule out malignancy 1

Ligation Technique

• An alternative simple method involves ligating the base of the caruncle using 1-zero silk suture 3
• This technique:
  • Can be performed without anesthesia or analgesics
  • Allows the caruncle to break off naturally within 7-14 days
  • Permits tissue collection for pathological evaluation if needed
  • Requires at least one assistant during the procedure 3

Specific Surgical Approach

1. Preparation:

   • Position patient in lithotomy position 2
   • Administer appropriate anesthesia (local, regional, or general depending on patient factors) 2

2. Procedure:

   • For excision: The caruncle is grasped with forceps and excised at its base 1
   • For ligation: A suture is tied around the base of the caruncle, causing it to necrose and fall off within 1-2 weeks 3

3. Post-procedure Care:

   • Urethral catheterization may be required for several days 2
   • Local estrogen therapy may be prescribed, especially for postmenopausal women 2
   • Follow-up to ensure proper healing 1

Special Considerations

• Always obtain pathological evaluation of the excised tissue to rule out malignancy 1
• Recurrence is possible and may require repeat treatment 1
• For patients with unusual presentations or suspected malignancy, more extensive evaluation may be necessary 4
• In elderly patients, consider the potential for thrombosis within the caruncle, which may present as a black, hard area within the lesion 5

Pitfalls and Caveats

• Failure to obtain pathological examination may miss rare malignant conditions that can mimic caruncles 1
• Overaggressive excision can lead to urethral stenosis or meatal stricture 1
• Incomplete excision may result in recurrence 1
• The current literature lacks high-quality studies on the optimal management of urethral caruncles, so clinical judgment remains important 1