Giant urethral caruncle resembling urethral prolapse causing outflow obstruction

Area of Science:

• Geriatric Medicine
• Urology
• Pathology

Background:

• Urethral caruncle is a benign, fleshy growth typically found at the urethral meatus, primarily affecting postmenopausal women.
• While often asymptomatic, urethral caruncles can present with symptoms mimicking more serious conditions like urethral prolapse or malignancies.
• Complications such as urinary obstruction and retention are uncommon but significant presentations.

Observation:

• An 83-year-old female presented with a week of acute urinary retention.
• Physical examination revealed a significant bulging mass at the posterior lip of the external urethral meatus, causing outflow obstruction.
• The mass was surgically excised for diagnosis and relief of symptoms.

Findings:

• Histopathological examination of the excised mass confirmed the diagnosis of urethral caruncle.
• The case highlights that urethral caruncles, though common in the elderly, can present with obstructive symptoms.

Implications:

• This case underscores the importance of thorough physical examination to differentiate urethral caruncles from urethral malignancies or prolapse.
• Prompt diagnosis and management of symptomatic urethral caruncles are crucial for preventing complications like urinary retention.
• Further research into the etiology and management of symptomatic urethral caruncles in the elderly may be warranted.