Urethral prolapse
- Circumferential herniation or eversion of urethral mucosa.
- Appears as beefy-red donut shaped lesion at meatus or discoloured and darker.
- Commonly noted in 2 x populations – postmenopausal women and prepubertal girls.
- May be asymptomatic, or have bleeding/spotting or urinary symptoms.
- Can be observed, treated with Sitz baths and oestrogen, or excised with reapproximation of urethral mucosa to skin of vagina.
Urethral caruncle
- Inflammatory lesion, usually seen in post-menopausal women.
- Reddish exophytic mass. Occasionally thrombose and can become discoloured or purple.
- Usually posterior and not circumferential.
- Usually asymptomatic but may have some spotting or bleeding.
- Can be observed, treated with Sitz baths and oestrogen, or excised.
Rare DDx – urethral cancer, melanoma
Excision – around a catheter, fine absorbable interrupted sutures to reapproximate mucosa to vagina, ensure open and no stenosis, catheter for 5 days or so.