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Kifle AT, Mpelumb J, Bright F, Mbwambo OJ, Tsega TA. Urethral Caruncle in Pediatrics: A Northern Tanzania Experience. Case Rep Urol 2024; 2024:6104687. [PMID: 38601037 PMCID: PMC11006455 DOI: 10.1155/2024/6104687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/03/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in postmenopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present a case series of three pediatric patients with a urethral caruncle.
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Affiliation(s)
| | - Janeth Mpelumb
- Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Frank Bright
- Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Zuo SW, Napoe GS. Evaluation and management of urethral and periurethral masses in women. Curr Opin Obstet Gynecol 2023; 35:517-524. [PMID: 37678190 DOI: 10.1097/gco.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW Female periurethral masses are an uncommon occurrence. The purpose of this review is to describe etiologies of female urethral and periurethral masses and to provide an update on diagnosis and management. RECENT FINDINGS The most common causes of periurethral and urethral masses in women are urethral caruncles, urethral diverticula, and Skene's gland cysts. Urethral meatal lesions such as urethral caruncles and prolapse can be managed conservatively with topical estrogen therapy and close follow-up or should be excised in the setting of thrombosis, significant or recurrent bleeding, acute urinary retention, or persistent pain. Benign periurethral gland masses, such as Skene's gland cysts, Gartner's duct cysts, and Mullerian duct cysts, remain rare. Recent case series reveal a high rate of surgical management of these lesions with few complications. Urethral malignancy or malignant transformation of benign etiologies are even rarer but can be aggressive in nature and should be treated promptly. SUMMARY Nonspecific urinary and vaginal symptoms as well as similar physical presentations make diagnosis of urethral and periurethral lesions in females difficult. Magnetic resonance imaging is useful for differentiation of periurethral masses. The decision for conservative or surgical management is typically guided by patient symptom bother, as well as concern for urethral malignancy.
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Affiliation(s)
- Stephanie W Zuo
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital
| | - Gnankang Sarah Napoe
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital
- University of Pittsburgh School of Medicine
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
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Perrin A, Corcos J. Nonneurogenic female bladder outlet obstruction: Conservative and medical management. Neurourol Urodyn 2023. [PMID: 37929777 DOI: 10.1002/nau.25318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION In nonneurogenic female bladder outlet obstruction (BOO), management goals include reduction of outlet resistance to increase urinary outflow and improve bladder voiding to prevent or reduce lower and upper urinary tract (LUT and UUT) function deterioration, by correcting the underlying etiology. As significant progress has been achieved in the conservative and pharmacological management of nonneurogenic female BOO, the purpose of this article is to review and summarize the current literature. MATERIALS AND METHODS For this narrative review, a PubMed® search was performed by cross-referencing the keywords "female bladder outlet obstruction," "female voiding dysfunction," "conservative management," "pharmacological management," and "treatment" with various terms related to the management of female BOO. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. MANAGEMENT This review discusses and summarizes the conservative and pharmacological management of nonneurogenic female BOO based on the most relevant data currently available in the literature. CONCLUSION The recent advances in the understanding of underlying mechanisms involved in female BOO allow for more individualized management. Conservative and pharmacological options show interesting outcomes, particularly in the context of a functional cause of BOO. Overall, the level of evidence is still low regarding the use of conservative and pharmacological measures and more long-term data are required.
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Affiliation(s)
- Andry Perrin
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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El Boté H, Lakssir J, Boughaleb A, Bellouki O. Angiomatous Urethral Caruncle After Ureteroscopy: A Case Report. Cureus 2023; 15:e47528. [PMID: 38021618 PMCID: PMC10664771 DOI: 10.7759/cureus.47528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Urethral caruncle is a rare condition. Although relatively common in postmenopausal women, its occurrence after a urological endoscopic procedure is unusual. Here, we report the case of a postmenopausal woman who presented with a symptomatic urethral caruncle two weeks after a ureteroscopy for a right ureteral calculus. Treatment consisted of surgical excision of the mass after the failure of local estrogen application, and the postoperative aesthetic and functional result was satisfactory. Through a review of the literature, the etiological, diagnostic, and therapeutic aspects of this pathology will be discussed.
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Affiliation(s)
- Hicham El Boté
- Surgery, Faculty of Medicine and Pharmacy of Beni Mellal, Regional Hospital of Beni Mellal, Beni Mellal, MAR
| | - Jihad Lakssir
- Urology, Ibn Sina Hospital, University of Rabat, Rabat, MAR
| | | | - Omar Bellouki
- Urology, Ibn Sina Hospital, University of Rabat, Rabat, MAR
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Khoja S, Arafat W, Kohaut E, Horstmann M. [Surgical treatment of urethral prolapse]. Aktuelle Urol 2022; 53:535-539. [PMID: 33853158 DOI: 10.1055/a-1351-8900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urethral prolapses in humans are rare. Urethral caruncula are more frequent. Caruncula originate from the dorsal external layer of the urethral meatus. We report on the surgical approach used for the resection of a huge urethral prolapse in a postmenopausal woman with chronic constipation using the four-quadrants resection technique. After the procedure, the patient was quickly relieved from pain and micturition was improved. The patient was fully continent. Alternative treatments to surgical resection include conservative approaches with sitz baths and oestrogen cremes, manual reduction under general anaesthesia and ligation of the prolapse around a transurethral bladder catheter.
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Affiliation(s)
- Safwan Khoja
- Helios Krankenhaus St. Josefshospital, Klinik für Urologie und Kinderurologie, Krefeld Uerdingen
| | - Wasseem Arafat
- Helios Krankenhaus St. Josefshospital, Klinik für Urologie und Kinderurologie, Krefeld Uerdingen
| | - Eva Kohaut
- Augusta-Kranken-Anstalt gGmbH, Institut für Pathologie und Zytologie, Bochum
| | - Marcus Horstmann
- Helios Krankenhaus St. Josefshospital, Klinik für Urologie und Kinderurologie, Krefeld Uerdingen.,Klinik für Urologie, Universität Duisburg-Essen, Essen
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Maetzold E, Takacs EB. Urethral Pathology in Women. Curr Urol Rep 2022; 23:225-234. [DOI: 10.1007/s11934-022-01109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
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Wang X, Lei J, Zhang W, Zhou J, Song L, Ying T. The ultrasonographic characteristics of female periurethral solid masses. Int Urogynecol J 2022; 33:605-612. [PMID: 35006310 DOI: 10.1007/s00192-021-05022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Studies on the imaging of female periurethral masses are sparse, and most are focused on cystic lesions. In this article, we studied female periurethral solid masses and reported their ultrasonographic features. METHODS Fifteen women with periurethral solid masses pathologically diagnosed between January 2008 and April 2021 were assessed. RESULTS Each patient had only one mass. The pathological types included urethral caruncle (5 patients), urethral leiomyoma (3 patients), urethral malignant tumor (MT) (3 patients), periurethral spindle tumor (3 patients) and cartilage necrosis of pubic symphysis (PS) (1 patient). On ultrasound, all urethral caruncles were located at the urethral meatus. They were hypoechoic/isoechoic and rich in blood flow signal. Each leiomyoma presented as a well-defined hypoechoic mass with an oval shape. The urethral MT had inhomogeneous/isoechoic echoes, with medium to abundant blood flow signal. The spindle cell tumors had regular/irregular shapes, moderate/high density echogenicity and little/rich blood flow signals. The articular cartilage necrosis of PS was regular in shape, with mixed echogenicity and no blood flow. CONCLUSIONS Ultrasound imaging is a convenient and useful method to evaluate the morphological characteristics of female periurethral solid masses.
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Affiliation(s)
- Xia Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jiewen Lei
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Wei Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Junhong Zhou
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Savvas C, Araklitis G, Shah C, Robinson D, Cardozo L. Urethral bulking agent found in a urethral caruncle which did not respond to topical oestrogens: A case report. Case Rep Womens Health 2020; 28:e00268. [PMID: 33163369 PMCID: PMC7609486 DOI: 10.1016/j.crwh.2020.e00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Urethral caruncles are lesions occurring at the urethral orifice, around the posterior lip of the urethra. They are the most common benign growth of the female urethra. They are often asymptomatic and found incidentally on clinical examination. When symptomatic they commonly present with bleeding. Treatment includes vaginal oestrogens or, failing that, surgical excision. We present an unusual finding after excision of a urethral caruncle. Case A patient with a background of stress urinary incontinence had numerous pelvic surgeries, including colposuspension, tension-free vaginal tape (TVT) and Macroplastique (a urethral bulking agent). She developed bleeding from a 3 cm urethral caruncle, which did not improve with vaginal oestrogens. She proceeded to have a surgical excision of the caruncle. Histology revealed a foreign material with surrounding foreign-body-type multinucleate giant cell reaction. The material was compatible with Macroplastique. Conclusion This case report describes an unusual and unexpected histological finding. Macroplastique is injected in the urethra, 10–15 mm from the bladder neck. We suspect the caruncle dragged the Macroplastique material out through the urethral meatus. If urethral caruncles are not adequately treated with vaginal oestrogens, surgery should be considered. Urethral caruncles are lesions occurring at the urethral orifice, around the posterior lip of the urethra They are the most common benign growths of the female urethra When symptomatic they commonly present with bleeding. Treatment includes topical oestrogens or failing that, surgical excision. The presence of a urethral bulking agent in a caruncle, which did not respond to topical oestrogen, is reported.
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Affiliation(s)
- Christopher Savvas
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
| | - George Araklitis
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
| | - Chirag Shah
- Department of Histopathology, King's College Hospital, SE5 9RS, UK
| | - Dudley Robinson
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
| | - Linda Cardozo
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
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