Urethral caruncle in a perimenopausal female: Dramatic response to topical estrogen cream.

Dear sir,

Urethral caruncle is a benign vascular tumor, which usually arises from the posterior lip of the urethral meatus. It represents the most common lesion of the female urethra and occurs primarily in postmenopausal women.[1] Most cases are asymptomatic, but sometimes, patients feel a lump or bleeding at the urethral meatus. Symptoms are dysuria, dyspareunia, hematuria, and rarely a sensation of pressure in the perineal region.[2] Giant urethral caruncle presenting as genital prolapse[3] and as a cause of acute urinary retention[2] has been described in literature. Pediatric cases with urethral caruncle have also been reported,[4] but cases in perimenopausal women are rarely seen. Herein, we report a case of urethral caruncle in a perimenopausal woman.

A 39-year-old female patient was referred from the gynecology department with the complaints of burning and pain sensation during micturition for 3 months. There was no history of stress or urge incontinence, hematuria, and dyspareunia. Physical examination revealed single, 1 cm × 1 cm-sized, dark red mass that was soft on palpation, originating from the posterior lip of the external urethral meatus [Figure 1]. The lesion did not bleed on touch. The patient's obstetric history was uneventful. Routine hematological and biochemical investigations were normal. The patient was advised topical estrogen cream for 4 weeks and the lesion resolved completely in 4 weeks [Figure 2].

Figure 1

Single, soft, dark red mass at the posterior lip of the external urethral meatus

Figure 2

Dramatic improvement after 4 weeks of topical estrogen application

Urethral caruncle is the most common lesion of female urethra and is often observed in postmenopausal women. It consists of vascular connective tissue loosely surrounded with transitional and squamous epithelial cells. The most important risk factor in its etiology is hypoestrogenemia.[5] They are inflammatory nodules arising at the posterior lip of the external meatus, present as solitary, soft, raspberry-like pedunculated tumors.[1] Urethral caruncles in 32% of cases are asymptomatic. When present, the most common symptoms are dysuria, pain or discomfort, dyspareunia, and rarely bleeding. The mass may be large and bleeds easily.[6] Although the initial medical treatment of urethral caruncle is topical estrogen cream and anti-inflammatory treatment, symptomatic and larger lesions may be surgically excised.[2] Our patient was successfully treated with medical treatment.

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