What is it?
A red fleshy lesion seen protruding from the urethral meatus (the opening where the urine comes out).
Why do they occur?
We don’t really know but they are mainly seen in women after the menopause. It is thought that as a result of oestrogen deficiency initially some of the mucosal lining of the urethral prolapses.
Chronic irritation of this tissue can then cause growth, bleeding and necrosis.
What symptoms can it cause?
Most are asymptomatic and small and do not require any treatment. It is advisable to monitor them though to make sure they are not growing.
Does it need treatment?
If they are symptomatic or enlarging then they should be treated as tumours are found in about 2%. Symptoms include pain, bleeding, burning passing urine, or a bothersome lump.
What are the non-surgical treatment options?
Warm sitz baths, topical oestrogen creams and topical anti-inflammatories.
What if surgery is required?
Surgery may be recommended if the lesion is large, growing, suspicious or failing to respond to the above treatments. A cystoscopy is performed at the time of surgery to exclude pathology further up the urethra or in the bladder. The lesion may be excised and the edges left to heal or sewn together with dissolvable sutures depending on the size of the lesion. The procedure takes about 10 minutes. A catheter may be placed for 1-2 days although not usually necessary for smaller lesions. No special follow up is required if the lesion is benign other than a routine post-operative visit.
What are the risks of surgery?
- Bleeding. Minor bleeding can occur on and off for a few weeks after surgery whilst the wound heals.
- It is usual to have pain when passing urine for the first week.
- Infection including urine infection
- Recurrence
- Stenosis or narrowing of the meatus (opening for passing urine) due to scarring which can require further surgery to correct.
- There are general medical risks of abdominal, cardiovascular (heart), and pulmonary (lung) illnesses; 2-5% from surgery under general anaesthesia. These include Deep Vein Thrombosis (blood clots in deep leg veins), Pulmonary Embolus (these clots dislodging and going to the lungs), pneumonia, Myocardial Infarction (heart attack) and Cerebrovascular Accident (stroke). There is a small risk of death; < 5 in 10,000.
