What Is Urethral Caruncle?

Overview

Urethral caruncles a benign (noncancerous) polypoid (an outgrowth resembling polyps) urethral lesions. It occurs outside the urethra (the opening from which the urine comes out).¹ Although there have been a few unusual occurrences documented in premenopausal AFABs (assigned female at birth), postmenopausal AFABs are the ones who experience it the most frequently.^4,7

Several authors frequently equate the urethral caruncle with urethral prolapse and urethral polyps. Usually observed in premenarchal AFABs or postmenopausal AFABs, urethral prolapse is a circumferential protrusion of the mucosa surrounding the urethral meatus (meaning the urethra sticks out on all edges). Urethral caruncle, in contrast, is a single quadrant mucosal prolapse that is typically observed in postmenopausal AFABs (meaning only one edge of the sticks out). There have only been 14 pediatric cases described in English literature thus far.⁶

They are frequently discovered during a pelvic examination and are typically asymptomatic. Bleeding, hematuria (the presence of blood in urine), discomfort, dysuria (painful urination), or a lump have all been identified when they start to show symptoms.

The urethral caruncle is a disorder that has been known to exist in medicine for more than two centuries, although it is still not well understood. The current body of research primarily falls short of instructing general practitioners on managing the illness appropriately. Urethral caruncles are typically little but can increase in size to between 1 and 2 cm in diameter. A pedicle or a broad base that may extend into the canal is used to attach the growth to the urethral edge, which is where it almost invariably appears on the bottom half of the meatus. The growth is typically florid or dusky red in colour. The appearance can be flat, rugose, somewhat raised, or it can be a narrow tumour with a pedicle and a sharply crenated edge that protrudes from the urethra and is constrained by the nymphae. Although it normally only has one, there could occasionally be two or more. 

It is primarily a vascular growth, and Dr Skene, a Scottish doctor who conducted a special investigation into urethral neoplasms, used the term "papillary polyploid angioma" to refer to it. He also described it as "a bunch of dilated capillaries set in the moderately dense stroma of connective tissue, covered with mucous membrane which has the usual pavement epithelium." Although many believe they are amply supplied with nerve tissue, which partially explains their high sensitivity, the presence of any unusual number of nerve fibres or unusual configuration of nerve endings has not been satisfactorily proved.

Where do you get a urethral caruncle?

A little, benign growth or area of skin on the exterior of your urethra (the opening from which the urine comes out) is known as a urethral caruncle. Your urethra's portion that has protruded (or poked out) on one edge is this tissue or skin.

Symptoms of urethral caruncle

Most people with urethral caruncle do not experience any symptoms, but in some cases, people might experience symptoms like:⁵

• Pain: It is the main symptom and can manifest as mild or severe depending on the case 
• Dyspareunia: A common symptom that results in a disturbance of the neurological system (pain in the genital before, during or after intercourse) 
• Many people complain about pressure while walking or sitting, particularly from clothing or sanitary products 
• Rarely, prolonged urine retention is observed, and this is usually the result of the person trying to delay uncomfortable movements
• When the veins are close to the surface, haemorrhages can happen. These can range from little discolouration to bleeding of frightening magnitude, especially if they happen repeatedly
• In extreme circumstances, the ongoing discomfort may result in irritability, depression, hunger loss, weight loss, sleep loss, and occasionally, severe nervous upheavals, the cause of which is frequently completely disregarded 

Causes of urethral caruncle

The precise reason is unknown. At any age, it might happen. It is most frequently observed in multiparae (AFABs with two or more viable pregnancies) and is most prevalent just before, during, or right after menopause. Low levels of oestrogen can also contribute to the development of urethral caruncle. Gonorrheal urethritis, which causes inflammation of the Skene ducts, is suggested to be a contributing factor in young AFABs. Cystocele and urethral prolapse are thought to be the causes of chronic cystitis in older AFABs.

Who is at risk?

Urethral caruncle typically develops from the urethral meatus's posterior lip. It is the most prevalent lesion of the AFAB's urethra and mainly affects postmenopausal AFABs. There has been only one case recorded in AMABs (assigned male at birth).

How is a urethral caruncle diagnosed?

The diagnosis is usually easy to make by pelvic inspection or examination. Sometimes, the condition is so delicate that a thorough inspection is impossible, and this alone is evidence in favour of a caruncle. The urethral caruncle must be distinguished from a number of disorders that might affect this area. Sometimes, urethral polyps, which are often less sensitive and frequently attached higher in the urethra, can be mistaken for caruncles. Another condition that affects this area is prolapse of the urethra, but the main distinction is that the prolapse affects the full circle of the meatus, whereas the caruncle is almost always on the lower half and a tiny portion of that. Painful urination, which is a nearly constant sign of caruncle, is typically not associated with inflammation of the Skene's ducts. The openings of the glands can frequently be visible as well, and pus can sometimes come out of them. Even though cancer at this stage is extremely uncommon, your healthcare provider will carry out tests like biopsies and cystoscopy to rule out all possibilities.

Prevention

Hormone therapy may help lower risk because urethral caruncles are connected to low estrogen levels.³ Consult your healthcare provider regarding the best prevention option available for you. 

Treatment and home remedies

Unless the growth is producing uncomfortable symptoms, treatment is not required. Your healthcare practitioner might suggest treatment if your urethral caruncle is impairing your quality of life. The following are the most typical urethral caruncle treatments:

• Topical oestrogen cream: Using this cream promotes the replenishment of oestrogen
• Anti-inflammatory drugs: To reduce inflammation and swelling
• Surgery: To remove a urethral caruncle under local, sedative, or general anaesthesia. It's crucial to remember that there is a potential for recurrence even after surgical excision

Warm sitz baths are an additional option. This calms the area and assists in reducing discomfort. Moreover, some people use petroleum jelly, which serves as a protective layer, easing any inflammation.²

When to seek medical attention?

Make an appointment with the doctor if you experience any burning sensation while urinating or when you notice soreness, blood, or swelling around your urethra.

Summary

Urethral caruncles are benign polypoid urethral lesions that often manifest as a fleshy protrusion at the distal urethral mucosa's posterior lip. They are typically seen in postmenopausal AFABs. Though mostly asymptomatic, some people might experience symptoms like bleeding, hematuria, discomfort, dysuria, or a lump. Pain is the main symptom of dyspareunia, which can manifest as mild to severe painful urination.

It is most common in multiparae and is most prevalent just before, during, or right after menopause. Chronic cystitis is thought to be the cause of chronic cystitis in older AFABs, and a benign vascular growth known as a urethral caruncle is the most prevalent lesion of the AFAB's urethra and mainly affects postmenopausal AFABs. Low oestrogen levels are also thought to be a contributing factor. A urethral caruncle is a benign (noncancerous) growth or area of skin on the exterior of your urethra that protrudes (or pokes out) on one edge. Your healthcare provider conducts various examinations to distinguish other disorders that affect this area, such as prolapse of the urethra. Treatment includes topical estrogen cream, anti-inflammatory drugs, warm sitz baths, and petroleum jelly.