Background Information:

What are the other Names for the Procedure?

• Excision of Urethral Caruncle
• Removal of Urethral Caruncle
• Urethral Caruncle Excision

What is the Urethral Caruncle Removal surgical procedure?

The Urethral Caruncle Removal procedure involves the surgical removal of the urethral caruncle.

• The urethral caruncle is a benign tumor or lesion that arises at the opening, or rather at the lip of the urethra, in females
• They are usually small, but can grow up to 2-3 cm in diameter
• Rarely, these have been observed in males, as well

What part of the Body does the Procedure involve?

The body parts involved in Urethral Caruncle Removal procedure is the urethra and vagina.

Why is the Urethral Caruncle Removal surgical procedure Performed?

The Removal of Urethral Caruncle procedure is generally performed, only in cases of extreme discomfort or excessive bleeding, when the caruncles are not responsive to therapy using conservative methods.

What are some Alternative Choices for the Procedure?

Surgical removal of the caruncle is the last line of treatment; presently, there are no alternative choices available.

What are the Recent Advances in the Procedure?

Various developments are being carried out to ensure a much lesser invasive method, which is less painful and heals much quicker.

What is the Cost of performing the Urethral Caruncle Removal surgical procedure?

The cost of Urethral Caruncle Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Urethral Caruncle Removal procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.atlasofpelvicsurgery.com/1VulvaandIntroitus/2excisionofurethralcaruncle/chap1sec2.html (accessed on 08/02/2014)

http://www.mdguidelines.com/caruncle-of-the-urethra-benign (accessed on 08/02/2014)

Prior to Urethral Caruncle Removal surgical procedure:

How is the Urethral Caruncle Removal surgical procedure Performed?

The Urethral Caruncle Removal procedure is performed as follows:

• The vagina is held in place with the help of a speculum. The caruncle is located and cleansed. Two methods that may be used for the excision of the caruncle:
• The caruncle is held using a clamp and excised with the help of a scalpel. The specimen is removed and the mucosa that is visible is closed with the help of thin, absorbable sutures
• The caruncle is cauterized with the help of a diathermy ball and allowed to heal (electrocauterization)

Where is the Procedure Performed?

The Urethral Caruncle Removal procedure is performed at an out-patient surgical facility, or in the hospital.

Who Performs the Procedure?

An urologist or an obstetrician-gynecologist performs the Excision of Urethral Caruncle procedure.

How long will the Procedure take?

It takes about 30-60 minutes to perform the Urethral Caruncle Removal procedure.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician, if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Urethral Caruncle Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Urethral Caruncle Removal surgical procedure?

The following tests are required prior to the Urethral Caruncle Removal surgery:

• Routine blood examinations
• Urine analysis (to check for infections)
• Pelvic examination
• Pap smear test - to screen for pre-cancerous or cancerous cells
• Cystourethroscopy - to check for bladder or urethral abnormalities

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is the Urethral Caruncle Removal procedure?
• Why is this procedure necessary?  
• What does the procedure involve?
• How will this procedure help?
• Will I need adjunct treatments after the surgery?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place while recovering?
• When can I resume normal work?
• Is there any lifestyle restriction after the procedure is performed?
• After recovering from the procedure, are there any follow ups or tests? If yes, then how often?
• Are there any life-long medications that need to be taken after the procedure?
• How many procedure have you performed?

During the Urethral Caruncle Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the Urethral Caruncle Removal procedure the patient is administered local anesthesia either with or without sedation. However, in some cases, general anesthesia may be administered.

How much Blood will you lose, during the Procedure?

The blood loss is minimal and generally no transfusion is required, unless any complications arise, during the Urethral Caruncle Removal surgery.

What are the possible Risks and Complications during the Urethral Caruncle Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Urethral Caruncle Removal surgery are:

• Excessive bleeding
• Accidental damage to nearby tissue
• Infection
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Urethral Caruncle Removal surgical procedure?

Generally, the patient can go home right after a Urethral Caruncle Removal surgery. No post-operative care is required at the facility, unless any complications arise.

After the Urethral Caruncle Removal surgical procedure:

What are the possible Risks and Complications after the Urethral Caruncle Removal surgical procedure?

Post Urethral Caruncle Removal procedure, the following complications may arise:

• Surgical-wound infection
• Pain, redness, swelling or bleeding
• Meatal stenosis: Difficulty in passing urine, in which case an urine drainage catheter may be placed for a few days

What is the Prognosis after the Surgery?

The outcome of the Urethral Caruncle Removal procedure is generally excellent, once the lesion/tumor is removed.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms after a Urethral Caruncle Removal surgery:

• Pain, swelling, redness, drainage or bleeding in the surgical area increases
• Passing of urine is painful or difficult
• Any signs of infection
• Fever, headache, muscle ache, dizziness or weakness

What Post-Operative Care is needed at Home after the Urethral Caruncle Removal surgical procedure?

• There is no much post-operative care required, after the Urethral Caruncle Removal surgery
• However, the patient must regularly take medications and apply ointments, prescribed by the healthcare provider

How long does it normally take to fully recover, from the Procedure?

It takes about 2 weeks to fully recover from a Urethral Caruncle Removal procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The lesion or tumor is generally sent for histochemical and pathological analyses, to examine for the presence of any cancer cells, or any other pathology, like tuberculosis.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Urethral Caruncle Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• The urologist or gynecologist
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• A radiologist (if radiological tests were performed during the procedure)

Individuals are advised to inquire and confirm the type of billing, before the Urethral Caruncle Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA