Can Urethral Caruncle Cause UTI?
Urethral caruncles do not directly cause urinary tract infections, but they can present with overlapping symptoms that may be confused with UTI, including dysuria, hematuria, and urethral discomfort. 1, 2
Understanding Urethral Caruncles
Urethral caruncles are benign fleshy outgrowths at the urethral meatus, occurring predominantly in postmenopausal women at the posterior lip of the urethra. 1, 2 The lesions consist of hyperplastic urothelial and squamous lining overlying variably fibrotic, edematous, inflamed, and vascular stroma. 2
Clinical Presentation Mimics UTI
The symptom overlap between urethral caruncles and UTI creates diagnostic confusion:
- Common caruncle symptoms include dysuria (20%), hematuria (27%), and pain (37%), which are identical to lower UTI presentations 2
- Lower UTI characteristically presents with dysuria, frequency, urgency, and suprapubic pain without fever 3
- Approximately 32% of caruncles are completely asymptomatic and discovered incidentally 2
No Established Causal Relationship
The medical literature does not establish urethral caruncles as a cause of UTI. 1, 2 A comprehensive systematic review found no studies demonstrating that caruncles predispose to or cause urinary tract infections. 1 Similarly, a clinicopathologic analysis of 41 cases found no conclusive association between caruncles and urologic disorders. 2
Rare Obstructive Complications
While not causing infection directly, urethral caruncles can rarely cause acute urinary retention through mechanical obstruction. 4 This bladder overdistension could theoretically increase UTI risk through urinary stasis, though this mechanism is not documented in the literature. 4
Clinical Approach
When a patient presents with dysuria and urethral symptoms:
- Perform urine culture to definitively diagnose or exclude UTI, as recommended for any suspected UTI with unclear etiology 3
- Conduct thorough pelvic examination to identify visible urethral lesions 1, 2
- Recognize that 10% of caruncles are clinically mistaken for malignancy, requiring histologic confirmation 2
- Understand that concurrent urothelial carcinoma occurs in 12% of caruncle patients, though urethral carcinoma itself does not develop 2
Treatment of caruncles does not require antibiotics unless concurrent UTI is documented by culture. 1 Topical estrogen therapy is commonly used for symptomatic caruncles, with surgical excision reserved for persistent or severely symptomatic lesions. 1, 4