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LETTER TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 4  |  Page : 308-309
 

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


Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India

Date of Submission18-Jun-2018
Date of Acceptance29-Jul-2018
Date of Web Publication01-Oct-2018

Correspondence Address:
Manisha Balai
Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_200_18

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How to cite this article:
Balai M, Gupta LK, Kumari A. Urethral caruncle in a perimenopausal female: Dramatic response to topical estrogen cream. Indian J Urol 2018;34:308-9

How to cite this URL:
Balai M, Gupta LK, Kumari A. Urethral caruncle in a perimenopausal female: Dramatic response to topical estrogen cream. Indian J Urol [serial online] 2018 [cited 2018 Dec 13];34:308-9. Available from: http://www.indianjurol.com/text.asp?2018/34/4/308/242474


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

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Figure 2: Dramatic improvement after 4 weeks of topical estrogen application

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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.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Cimentepe E, Bayrak O, Unsal A, Koç A, Ataoğlu O, Balbay MD, et al. Urethral adenocarcinoma mimicking urethral caruncle. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:96-8.  Back to cited text no. 1
    
2.
Coban S, Bıyık I. Urethral caruncle: Case report of a rare acute urinary retention cause. Can Urol Assoc J 2014;8:E270-2.  Back to cited text no. 2
    
3.
Hizli F, Cetinkaya K, Bilir G, Basar H. Giant urethral caruncle presenting as genital prolapse. Urol J 2014;11:1841-3.  Back to cited text no. 3
    
4.
Chiba M, Toki A, Sugiyama A, Suganuma R, Osawa S, Ishii R, et al. Urethral caruncle in a 9-year-old girl: A case report and review of the literature. J Med Case Rep 2015;9:71.  Back to cited text no. 4
    
5.
Everett HS, Williams TJ. Urology in the female. In: Campbell and Harrison Urology. 3rd ed., Vol. 3. Philadelphia, PA: Saunders Co.; 1970. p. 1957-70.  Back to cited text no. 5
    
6.
Conces MR, Williamson SR, Montironi R, Lopez-Beltran A, Scarpelli M, Cheng L, et al. Urethral caruncle: Clinicopathologic features of 41 cases. Hum Pathol 2012;43:1400-4.  Back to cited text no. 6
    


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  [Figure 1], [Figure 2]



 

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