Urethral Caruncle

Following a cholecystectomy, an indwelling urethral catheter was placed in a 51-year-old woman with urinary retention. Five days later, the patient complained of a burning sensation at the site. A rounded, swollen, hemorrhagic area surrounding the catheter was noted, and a urinary tract infection was diagnosed.

Robert P. Blereau, MD of Morgan City, La, writes that a urethral caruncle is a sessile polypoid growth that develops circumferentially around the urethral meatus in women. These fairly common, usually asymptomatic lesions are the color of the surrounding tissue or may be somewhat red. Their origin remains undetermined, but it is thought that they may be associated with estrogen deficiency in aging women. In rare cases, a caruncle may cause urethral obstruction and urinary tract infection. Trauma associated with intercourse or vigorous wiping with toilet tissue can cause the lesion to bleed.

The patient, who was unaware of the urethral caruncle, denied any trauma to the catheter area; however, it is suspected that she may have accidentally pulled on the tubing while asleep. Nitrofurantoin was prescribed, and the infection cleared.

A urologist excised and cauterized the swollen area. Pathologic findings-segments of squamous and urothelial mucosa with prominent hemorrhage, acute inflammation, and focal ulceration with reactive epithelial/urothelial atypia and no evidence of malignancy-confirmed the diagnosis of urethral caruncle.

Urethral catheterization was required for 2 weeks after the surgery. The patient's recovery was uneventful; she had no symptoms at the 4-month follow-up.