The female urethra is about 4 cm long and 8 mm in diameter. It is slightly curved and lies beneath the pubic symphysis just anterior to the vagina. Urethral lesions are important diagnostic tools in female urology. A urethral caruncle is a benign vascular tumor usually originating from the rear lip of the external urethral meatus, respectively, usually arise from the posterior lip of the urethral meatus and often observed in postmenopausal women. Although the etiology of urethral caruncles is still undetermined, they are the most common benign tumors of the female urethra including inflammatory polyps, cysts (Bartholin’s), prolapse of the urethra, urethral cancer, and diverticulum. Most cases are frequently asymptomatic, but, sometimes patients feel a lump or bleeding at the urethral meatus and sometimes it might cause acute urinary retention. Urethral caruncle is not included within the list of bladder overdistension causes in women. We present a huge urethral caruncle as a rare cause of acute urinary obstruction in a 51 year old woman, who asked for medical help on our emergency unit . The family referred that she was unable to urinate for the last 12h. The physical examination revealed bladder overdistension (globus vesicalis) and acute urinary retention. The patient’s history revealed a gradual reduction in urine flow for the last year and the presence of blood stains on her underwear over the past month. On a pelvic examination, there was a 3 × 2.5 cm dark red mass protrudring circumferentially from the urethra that was soft on palpation and originating from the posterior lip of the external meatus, was found during catheterisation. The case was evaluated with physical examination and the bladder was evacuated with a 12-Fr urethral catheter. In total, 1200 cc residual urine was removed. She had normal preoperative serum blood urea nitrogen (BUN) and creatinine levels. Before the surgical treatment we performed urethrocystoscopy which was normal. The patient was placed in the dorsolithotomy position.The caruncle was excised under general anesthesia. The lesion was totally resected (excision) and settled with 4-0 absorbable sutures and an 18 French (F) Foley silicon catheter was placed for urine drainage. There were no complications. The patient was discharged on the third postoperative day, the urethral catheter was removed on the seventh day and afterward the patient started to urinate easily. After surgical excision the histopathological report confirmed urethral caruncle. Local estrogen creams were also applied during the postoperative period. The postoperative period was uneventful and no signs of residual complaints were observed after 12 months of follow-up.
An impacted urethral stone: a rare cause of acute urinary retention in women—case report
