Urethral Caruncle

(Prolapsed Urethra)

A nodular mass of erythematous urethral mucosa protruding through the external urethral orifice.

Prolapse of the urethral mucosa most often occurs in children and postmenopausal women. It is caused by redundancy of the mucosa combined with laxity of the periurethral fascia, and it may be aggravated by an increase in intra-abdominal pressure and a relative lack of estrogen.

Patients may be asymptomatic or may present with urethral bleeding, urinary urgency or frequency, or dysuria. Unlike a neoplasm, which generally is firm and nontender, a caruncle is soft and may be tender.

Asymptomatic caruncles generally require no treatment. In a patient who is hypoestrogenic, vaginal estrogen cream may help alleviate symptoms; if symptoms continue, caruncles can be removed using cauterization, laser vaporization or excision, cryotherapy, or surgical excision.