What Is Urethral Prolapse, and Is It Treatable

What Is Urethral Caruncle?

Urethroplasty (UR) is a surgical procedure where the opening of the urethra is closed with sutures or stitches. The surgery usually involves cutting out part of the urethra and stitching it up so that urine doesn’t leak through.

In some cases, the urethra may not have been completely destroyed and there may still be a small hole left. This is called a “caruncle” or “bulge.” These bulges are often seen in older men, especially those who smoke. They can cause discomfort when urinating and sometimes lead to infection.

Urinary incontinence is another possible complication of UR. Urinary incontinence occurs when the bladder muscles don’t relax properly during urination. This causes the flow of urine to stop altogether, which results in leakage of urine from the urethra. If untreated, urinary incontinence can result in painful urination and even kidney damage if not treated promptly. For this reason, it’s important to see a doctor if you’re concerned about incontinence following your urethroplasty.

Urethral Caruncle vs. Prolapse

Urethral caruncles and urethral prolapses share a lot of similarities, but they’re also significantly different conditions.

A urethral caruncle is a bulge on the opening of the urethra that typically does not extend into the urethra itself. Caruncles can appear on the glans (tip) of the male genitalia and are common in older men who have a history of urethral trauma or surgery. Most caruncles do not require treatment, but they can lead to frequent urinary tract infections (UTIs).

Urethral prolapse occurs when the urethra actually protrudes out of its normal position. It is more common in women than men and can be extremely painful. While urethral caruncles do not typically require treatment, treatment for urethral prolapse focuses on reducing the size of the cystocoele before it is repaired. Urethral prolapse is a condition that should be addressed by a medical professional immediately upon diagnosis.

Urethral Prolapse After Childbirth

A urethral prolapse can occur in women after a traumatic delivery of an infant. This is typically due to lacerations or tears in the skin that lines the vaginal opening or around the urethra. Both forceps- and cesarean-section deliveries can cause these lacerations. Similar to caruncles, these lacerations can also lead to frequent urinary tract infections (UTIs).

Urethral prolapses are typically classified as Grade I, II, or III. A Grade I prolapse is the least severe and involves only the skin around the urethra. A Grade II prolapse involves the urethra and some surrounding tissue. A Grade III prolapse involves all of the urethra as well as some of the surrounding tissue.

Urethral prolapse is typically treated with surgery. If the prolapse is only skin-deep, your physician may opt to use sutures or stitches to close off the vaginal opening to prevent additional trauma and potential infection. If the prolapse involves the entire urethra, your physician may opt for a more involved procedure. There are a few different surgical solutions to repair the urethra, including using skin grafts or vaginal flaps.

A skin graft involves removing a strip of healthy skin from elsewhere on the body (often the buttocks or thigh) and attaching it to the urethral opening. A vaginal flap, also called a mucosa graft, involves taking a length of tissue from the vaginal wall and using it to reinforce the urethral opening. Both of these procedures are typically successful in repairing urethral prolapses and preventing future incontinence.

A Word From Verywell

Urethral caruncles and urethral prolapses are similar in that they can both lead to incontinence, but they’re different in severity. Urethral caruncles are benign growths on the opening of the urethra, while urethral prolapses involve the urethra actually protruding from its normal position. If you experience pain with urination or notice blood in your urine, contact your physician immediately.

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Vulvovaginitis and other common vulvar disorders in children by ES Rome – Pediatric and Adolescent Gynecology, 2012 – karger.com

Urinary incontinence: a distressing symptom that is often treatable by L Nazarko – British Journal of Healthcare Assistants, 2018 – magonlinelibrary.com

Pelvic Organ Prolapse by A Tseng – arthurtsengwhs.com

VAGINAL COMPLAINTS by A Koyama, KS Brigham – URGENT CARE MEDICINE – academia.edu

Surgery and clinical imaging for pelvic organ prolapse by DS Hale – Imaging Pelvic Floor Disorders, 2008 – Springer

… Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence by P Abrams, KE Andersson, L Birder… – … : Official Journal of …, 2010 – pelvicfloorspecialist.com

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Vulvar disorders of the infant and young child by ML Dodds – Clinical obstetrics and gynecology, 1997 – journals.lww.com