Case report of an unusual presentation of a urethral caruncle.

Abstract

Introduction: Urethral caruncle is a benign lesion located at the urethral meatus, predominantly affecting postmenopausal women. Though often asymptomatic, it can sometimes present with symptoms that significantly impact the patient's quality of life. Diagnosis is usually straightforward based on physical examination. However, in some cases where there is diagnostic uncertainty or suspicion of malignancy, additional investigations may be necessary.

Clinical presentation: We present the case of a 59-year-old postmenopausal woman who reported urinary frequency and painful micturition persisting for two years. The patient also experienced a bulging sensation in the vaginal area, described as a feeling of a foreign body. Upon physical examination, a soft, protruding red mass surrounding the urethral meatus was observed, prompting further investigations due to its unusual appearance.

Discussion: Urethral caruncles are almost exclusively found in postmenopausal women. Often asymptomatic, they can cause bleeding, dysuria, or obstructive symptoms. The exact cause is unclear, but decreased estrogen post-menopause is a significant factor. Diagnosis typically involves physical examination, with biopsy needed if malignancy is suspected. Treatment is usually conservative, though surgical removal may be necessary for symptomatic or large lesions, with recurrence rates between 3.3 % and 12.5 %.

Conclusion: Urethral caruncles are the most prevalent benign urethral lesions in postmenopausal women. The variability in clinical presentation and the risk of misdiagnosis highlight the need for thorough clinical evaluation and individualized treatment strategies.