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Urethral Caruncle and Prolapse

Urethral caruncle is the most common benign tumor of the female urethra, occurring frequently after menopause. It presents as a reddish, sometimes tender, polypoid protrusion of the posterior lip of the urethral meatus (Fig. 11-8). The differential diagnosis of urethral caruncle includes urethral prolapse (see later), carcinoma of the urethra, thrombosis of a urethral vein, and a prolapsing urethral polyp. Caruncles are almost always benign, with only 2% found to be malignant. Biopsy is recommended when the presentation is atypical or the diagnosis is uncertain. Urethral caruncles often are asymptomatic and do not require treatment. However, they can sometimes cause bleeding, pain, or obstruction of voiding. In such cases treatment may be initiated. Topical estrogen can be used to reduce inflammation and relieve symptoms. In cases of a large and/or highly symptomatic caruncle, excision is recommended. Surgical excision consists of removal of the entire …