Excision of urethral caruncle

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What is a urethral caruncle?

A urethral caruncle refers to sagging inner wall of the urethra. It often happens after the menopause. Shrinkage of the surrounding tissues can lead to lax inner wall of the urethra.

Why do I need this kind of surgery?

A urethral caruncle does not always cause problems and does not necessarily need to be removed. It can sometimes cause bleeding or irritation. Rarely, it causes difficulty passing urine. If it is bothersome, it can be treated. Treatment starts with local oestrogen cream.

If this does not work, then cautery or more often removal, can be done to help improve symptoms.

What can I expect before the operation?

You will be invited for pre op assessment. This is when the nursing staff will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about that will make your stay with us more comfortable.

You will need to make arrangements for your family, children or any other commitments that you have, before coming in to hospital, and to cover the length of your recovery.

On admission, the nursing staff will go through your stay on the ward again to ensure you feel comfortable whilst in the hospital.

You will see an anaesthetist and the doctor performing the surgery before you go to theatre. It is not unusual to feel anxious; the nursing staff will gladly discuss how you are feeling and talk you through your emotions.

If you have not already signed the consent form when your operation was agreed and booked, the doctor will go through it with you before you go to theatre.

Will I have a general anaesthetic?

The operation can be done under general anaesthesia, spinal anaesthesia or local anaesthesia, with or without sedation. The choice will depend on your preferences. Discussions about anaesthesia take place during clinic consultations, before booking.

What does the operation involve?

The operation is done through the vagina. The redundant inner wall of the urethra is removed. The wall of the urethra is then closed with sutures. A catheter might be inserted for few days, to help healing. It is not uncommon to combine this with a camera examination of the inside of the urethra and bladder (cystoscopy). A separate information leaflet is available about this operation.

What are the risks?

There are risks with any operation but these are minor, as the operation is relatively minor. The main risks associated with this operation are:

Common risks:

• Postoperative pain. You will be provided with pain killers
• Wound infection, which may need antibiotics
• Wound bruising, breakdown and delayed wound healing
• Difficulty passing urine. You may have a catheter for few days and then come to a clinic or the ward to have it removed. This is usually for a short period of time, to allow healing and resolution of any swelling caused by surgery

Uncommon risks:

• Venous thrombosis and pulmonary embolism (blood clot in leg / lung). These are reduced by elastic stockings and injections that thin the blood to prevent clots
• The urethral caruncle may recur with time
• Bleeding requiring blood transfusion
• Return to theatre e.g. because of bleeding

In order for you to make an informed choice about your surgery please ask one of the doctors or nurses if you have any questions about the operation before signing the consent form.

What can I expect after the operation?

As you come round you may experience episodes of pain and / or nausea. Please let the nursing staff know and they will assess you and take appropriate action.

You will have a drip to give you fluids, though you will be able to eat and drink. It is not unusual to experience lower back pain and a feeling of fullness in your bowel and generalised discomfort when sitting. We use a pain score to assess your pain 0 to 10: 0 No Pain, 10 Very Strong Pain.

Your nurse will be checking your blood pressure, pulse, respirations and temperature and monitor any vaginal bleeding. S/he will also ask you to move from side to side and to do leg and breathing exercises once you are able. This will help prevent any pressure damage, a DVT (deep vein thrombosis) or chest infection.

What about going home?

The operation is usually carried out as a day case. You will be encouraged to sit up and start to walk, when you feel comfortable. You will be able to go home when you are passing urine without difficulty; unless you have a catheter, in which case you will be given a date to come back to have it removed.

What about follow up?

A follow up can be arranged, if required. This is usually organised for 12 weeks after surgery.

If you have problems, you can either contact your doctor or contact the hospital to arrange for an appointment or bring an arranged appointment forwards.

Are there any alternatives to this kind of surgery?

You will have been offered, and may have tried, local oestrogen cream before opting for surgery.

Who can I contact with any concerns or questions?

 If you have any problems or questions, you can contact:

References/useful links:

Patient.co.uk: urethral caruncle

If you do not understand this leaflet, we can arrange for an interpreter.

This information leaflet has been produced by Dr. Sharif Ismail, Consultant Subspecialist Urogynaecologist.

This information leaflet has been approved at the Clinical Governance and Safety and Quality Meetings of the Department of Obstetrics and Gynaecology as well as Brighton and Sussex University Hospitals NHS Trust Carer and Patient Information Group (CPIG).