Objectives: The female urethra may become involved by a variety of conditions, which may be challenging to providers who treat women. Mass-like urethral lesions need to be distinguished from other lesions arising from the anterior (ventral) vagina. Methods: A literature review was conducted. A Medline search was used, using the terms urethral neoplasms, urethral diseases, and female. Results: Reported lesions of the urethra were reviewed. Many of these lesions can be mistaken for each other clinically. Conclusions: A review of the scope of urethral lesions is presented to assist in developing a differential diagnosis if a patient with a urethral lesion is encountered. For practitioners who care for women, this will encourage communication and consultation where appropriate. ( J GYNECOL SURG 31:189)