Growth on Urethra: Diagnosis and Management
Immediate Diagnostic Approach
A growth on the urethra requires prompt evaluation to differentiate between benign lesions (urethral polyps, caruncles) and malignant urethral carcinoma, with biopsy or excision being essential for any suspicious mass. 1
Key Clinical Presentations to Identify
- Benign urethral caruncles (most common in postmenopausal women): fleshy outgrowth at posterior urethral lip, often asymptomatic or presenting with bleeding, hematuria, pain, dysuria, or visible lump 2
- Urethral polyps (more common in children): fibroepithelial growths that may arise from posterior urethra and extend to bladder, presenting with obstructive symptoms 3
- Urethral carcinoma (rare but critical): can mimic benign lesions clinically, requires high index of suspicion due to poor cancer-free survival if missed 1, 4
Essential Diagnostic Steps
After history and physical examination focusing on the mass characteristics (location, size, appearance, bleeding), proceed with: 5
- Cystoscopy with direct visualization to determine exact location, size, and characteristics of the growth 5
- Biopsy or complete excision for any suspicious lesion to rule out malignancy 1
- Retrograde urethrography (RUG) or voiding cystourethrography (VCUG) if stricture or obstruction is suspected 5
Treatment Algorithm Based on Lesion Type
For Benign Urethral Caruncles
- Observation is appropriate for asymptomatic, benign-appearing lesions based on patient preference 1
- Surgical excision is effective for symptomatic lesions or when malignancy cannot be excluded, with simple excision being the most common approach 2
- Conservative management lacks robust evidence but may include topical estrogen in postmenopausal women (though systematic studies are deficient) 2
For Urethral Polyps
- Transurethral excision is the primary treatment for accessible polyps 3
- Cystostomy approach may be necessary if endoscopic removal is unsuccessful, particularly for posterior urethral polyps extending to bladder 3
For Suspected or Confirmed Urethral Carcinoma
- Surgical resection remains the primary treatment, with modality varying by stage and location 1, 4
- Combination of surgery, radiation, and chemotherapy may be required, though optimal protocols remain unclear due to rarity of disease 4
- Maintain high suspicion as cancer-free survival is poor, necessitating aggressive evaluation of any suspicious urethral mass 1
Critical Pitfalls to Avoid
- Never assume a urethral mass is benign without tissue diagnosis, as urethral carcinoma can present identically to benign lesions 1
- Do not delay evaluation in postmenopausal women with bleeding urethral masses, as caruncles are common but malignancy must be excluded 2, 1
- Avoid incomplete excision of suspicious lesions; ensure adequate tissue for pathologic examination 1