Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl

Abstract

Urethral caruncle (UC) is a benign fleshy outgrowth at the urethral meatus. It was first described by Samuel Sharp in 1750 and occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. More often it was seen in the postmenopausal women, and only few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine. Here, we report the case history of a 4-year-old girl presented with vaginal bleeding which was taken as she has attended menarche and found to have urethral caruncle which was the cause for bleeding. Histology confirmed the diagnosis, and girl was completely cured following surgical excision.

Urethral Caruncle with Associated Renoureteric Anomalies

“…3 A ‘premature menarche’ without other secondary sexual characteristics may indicate a bleeding urethral caruncle. 5 The current patient had gross intermittent haematuria and a prominent perimeatal mass. The clinical differential diagnosis for a periurethral mass includes urethral prolapse, prolapsing ureterocele and a botryoid bladder or vaginal rhabdomyosarcoma.…”

“…Various treatment modalities are advocated ranging from conservative management with Sitz bath, oestrogen creams, topical corticosteroids to surgery. 1 , 5 , 7 In unresponsive cases or those exhibiting a progressive, irregular or suspicious growth, electrocoagulation of the base or excision are surgical options. 1 Surgical excision may cause urethral stenosis in a circumferential lesion.…”

A Rare Cause of Urinary Retention in Women: Urethral Caruncle

“…After almost three centuries of identification, its etiopathogenesis is still not fully illuminated. Many factors such as recurrent infections, chronic irritation, estrogen insufficiency and chronic inflammatory diseases with chronic granulation tissue formation are blamed for its etiology 4,9 . Histologically, urethral caruncles could have papillomatous, angiomatous or granulomatous morphology.…”

“…These lesions are mostly less than 1 cm and are asymptomatic 1,2 . However, patients can apply with very different symptoms such as hematuria, urethrorrhagia, dystonia, weak urine stream and urinary retention [2][3][4] . Almost all of the symptoms are directly related to the size of lesions.…”

Urethral Caruncle in Pediatrics: A Northern Tanzania Experience

“…Urethral caruncles are benign and pedunculated and appear as sessile polypoid lesions commonly over the posterior lip of the female urethral meatus, occurring primarily in postmenopausal women, although occasionally found in premenopausal women and prepubertal girls [ 1 , 2 ].…”