Urethral caruncles are the most common urethral lesion in postmenopausal women.
The lesion accounts for >90% of urethral masses in postmenopausal women 2.
Most women are asymptomatic, but caruncles can cause pain or bleeding. On physical examination, there is a protrusion of fleshy tissue from the posterior margin of the external urethral meatus.
The etiology has been hypothesized to involve chronic irritation in the setting of urethral prolapse and mucosal atrophy due to hypoestrogenic state 1,2.
Histologically, the lesion consists hyperplasic squamous and urothelial epithelium, fibrosis, and inflammation 1,2.
There is soft tissue thickening at the external urethral meatus, measuring 5-20 mm in size, usually anteriorly displacing the urethra, with the following signal characteristics 1,2:
- T2: hyperintense
- T1: hypointense
Treatment and prognosis
The treatment includes topical estrogen cream. A smaller percentage of lesions (<3%) are associated with carcinoma. If the lesion does not respond, excision can be considered to exclude malignancy.
- 1. Chaudhari VV, Patel MK, Douek M, Raman SS. MR imaging and US of female urethral and periurethral disease. (2010) Radiographics : a review publication of the Radiological Society of North America, Inc. 30 (7): 1857-74. doi:10.1148/rg.307105054 - Pubmed
- 2. Tomita H, Takeyama N, Hayashi T, Tanihuji S, Yamamoto K, Sasaki H, Ohike N, Nakajima Y, Hashimoto T. Magnetic Resonance Imaging of a Urethral Caruncle and the Pathologic Correlation: A Report of 3 Cases. (2017) Journal of computer assisted tomography. 41 (6): 962-964. doi:10.1097/RCT.0000000000000631 - Pubmed
- 3. Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King BF, Goldman SM. Imaging of urethral disease: a pictorial review. (2004) Radiographics : a review publication of the Radiological Society of North America, Inc. 24 Suppl 1: S195-216. doi:10.1148/rg.24si045504 - Pubmed