What Is the Meaning of the Urethral Caruncle?
The urethra is a tube-like structure present near the urinary bladder. It is a link between the bladder and the outside world. The main function of the urethra is to carry urine outside the body. In males, the urethra is a long tube that passes through the penis. In contrast, the urethra is short and located above the vagina in females. Urethral problems commonly occur due to aging, illness, and injury. Urethral caruncle, strictures, and urethritis are some of the common problems of the urethra. Pain, bleeding, and urethral discharge are the common symptoms of urethral problems. The urethral caruncle is a condition in which a small and non-cancerous growth is seen outside the urethra. As a result, the skin that forms the urethra has prolapsed at one end. Urethral caruncles are not serious and rarely require any treatment. However, they appear similar to other lesions, so the doctor might recommend some diagnostic tests.
What Are the Causes of Urethral Caruncle?
The exact mechanism of the formation of a urethral caruncle is unknown. However, scientists believe that the urethral caruncle is mainly associated with low estrogen levels. Estrogen is a hormone that plays a crucial role in a female's sexual and reproductive functions. Normally, estrogen keeps the skin around the genitals flexible and soft. However, estrogen levels become low during menopause. Due to low estrogen levels, the skin becomes dry and rough and tears down easily. As a result, the urethra becomes vulnerable to injuries and urethral caruncles.
What Is the Difference Between Urethral Caruncle and Urethral Prolapse?
Urethral prolapse and urethral caruncle might sound similar, but there is a vast difference between the two. Urethral prolapse is when the urethra protrudes out on all the edges. On the contrary, a urethral caruncle is a condition in which the urethra protrudes out only on one edge. Urethral caruncles are small, usually one to two centimeters in diameter. In contrast, a urethral prolapse is large and looks like a donut. The exact cause of both conditions is still unknown, but low estrogen levels have been attributed to these conditions. Usually, postmenopausal females are at a high risk of developing a urethral caruncle. Girls about to hit puberty are at the highest risk of developing a urethral prolapse.
What Are the Signs and Symptoms of a Urethral Caruncle?
A urethral caruncle is small in size and goes unnoticed. The patient hardly presents with any symptoms in the urethral caruncle. However, some patients might present with pain, bleeding, and a burning sensation while urinating. The urethral caruncle is usually red or pink but turns black or purple when blood clots form. Sometimes, the patient might notice blood on the undergarments, which might be mistaken for vaginal bleeding.
What Methods Are Used to Diagnose Urethral Caruncle?
A urethral caruncle is an incidental finding and might be noticed during a pelvic examination. The patient might be unaware of the presence of a urethral caruncle until it is noticed and pointed out by a doctor. The diagnostic methods are described below:
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Medical History: The medical history provides a general idea about the patient's health. The doctor mainly asks questions about the condition's symptoms, the time of their onset and progression, drug history, and family history. For example, the patient suffering from a urethral caruncle will mainly complain about dysuria (painful urination).
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Physical Examination: The doctor examines the patient to check the physical signs of the urethral caruncle. A pelvic exam is mainly performed to check the urethral caruncle. The procedure of pelvic examination is described below:
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Pelvic Examination: During a pelvic exam, the doctor looks at the genitals for irritation, soreness, or other problems. Next, the doctor inserts a plastic or metal instrument to get a detailed view of the vagina, cervix, and urethra. Urethral caruncles are usually reddish or pinkish nodules on the urethral opening. If the doctor feels that the caruncle needs to be examined closely, he might take a tissue sample (pap smear test) to examine the cells under a microscope. Finally, the doctor inserts a gloved and lubricated finger into the vagina to palpate the abdomen, pelvis, and urethra.
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Urinalysis: Urinalysis is not significant in diagnosing urethral caruncle, but the doctor might recommend it if the patient presents with dysuria and haematuria. In this procedure, the patient must collect the urine in a container or a sterile bag. The urine sample is examined in a laboratory under a microscope. This test helps to check the urine output and the presence of blood and bacteria in the urine.
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Cystourethroscopy: It is a type of imaging test done to diagnose and treat urinary tract problems. A telescope-like instrument called a cystoscope is inserted into the urinary bladder through the urethra. It helps to visualize the urethra and the bladder lining. Urethral caruncles will be visible with the help of a cystoscope.
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Biopsy: Biopsy is usually done to rule out other conditions like urethral cancer, melanoma, and sarcoma. First, a needle is injected into the urethra to obtain a tissue sample. Next, the sample is examined under the microscope to check the growth of cancerous cells.
How Is a Urethral Caruncle Managed?
The patient might not require any treatment until the caruncle causes symptoms that interfere with the patient's daily activities. However, the following treatment options are recommended if the patient is uncomfortable due to the symptoms:
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Warm Sitz Bath: A warm sitz bath or a shallow bath helps to ease the symptoms of pain and inflammation due to the urethral caruncle. Add warm water to a clean bathtub and soak your perineal region in the tub for 15 to 20 minutes. Check the water's temperature and ensure it is warm and not hot.
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Topical Estrogen Cream: As the name suggests, this cream contains the hormone estrogen. So, applying this cream makes the skin soft and helps restore the body's estrogen levels.
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Anti-Inflammatory Medications: Topical anti-inflammatory cream, mainly a corticosteroid, is usually recommended to overcome swelling, irritation, and itching.
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Surgery: If the non-surgical options do not work, surgical intervention is required to remove the urethral caruncle. Sometimes, the growth becomes abnormally large, and the patient is not left with any other treatment option other than surgery. The surgery is done under local or general anesthesia so that the patient does not feel pain during the procedure. The overgrowth of the caruncle is removed, and the incision is closed with sutures. A tube, like a catheter, is left in place for a few days to facilitate urine drainage.
Which Other Conditions Resemble a Urethral Caruncle?
Several conditions appear similar to urethral caruncle, and a proper diagnosis can be made only after a biopsy. The following conditions look like urethral caruncle:
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Urethral melanoma (a type of skin cancer).
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Urethral leiomyoma (a type of benign tumor that arises from the muscle fibers of the urethra).
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Lymphoma (cancer of the lymph nodes).
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Squamous cell carcinoma (skin cancer).
Conclusion:
Urethral caruncle, or an overgrowth of a part of the urethra, is commonly seen in females because of low estrogen levels. Menopause is a period where hormonal levels change drastically. The estrogen levels go down, making the urethral skin dry and itchy. As a result, a urethral caruncle occurs. Sometimes, the condition goes unnoticed because the patient does not present with any symptoms. Pain, bleeding, and a burning sensation while passing urine are the most common symptoms of a urethral caruncle. The condition is most often confused with urethral cancer, sarcoma, and lymphoma. The diagnosis can be confirmed only by cystoscopy and biopsy. The patient need not worry about the condition as surgical intervention is rarely required. However, consult the doctor to know more about the urethral caruncle and its treatment options.
