The urethra is a tube-like organ the carries urine from the bladder out of the body. In females the urethra is short and located in front of the vagina. Normal urine flow is painless and does not have any visible blood. Occasionally benign lesions or masses may form that disrupt this process. These lesions can include urethral diverticulum, paraurethral cysts, urethral caruncle, and urethral prolapse. Many of these lesions can be treated with nonsurgical interventions, but severe cases may require surgery.
Patient with urethral masses can experience a variety of symptoms including:
- UTI symptoms
- Pelvic pain
- Urinary urgency and frequency
- Pain with sexual intercourse
- Urinary leakage
- Blood in urine
- Trouble emptying bladder
Diagnosis of urethral masses is typically done by pelvic exam as well as a detailed medical history. Urine studies and a bladder ultrasound may also be done to help rule out other issues.
Imagining studies including an MRI or pelvic ultrasound may be done to help determine size of the mass and to ensure no other concerning features.
Your doctor may perform invasive testing such as cystoscopy where a tiny camera inside a long thin tube is inserted through the urethra to inspect the lining of the urethra.
Based on the type of urethral mass you are diagnosed with, there may be a variety of treatments your doctor may recommend.
Surgical excision is typically the treatment of choice. Occasionally patients who are not bothered by their symptoms may wait until they worsen prior to surgery.
These often shrink or drain with no intervention and if you have mild symptoms they can be watched. If a blockage, infection, or pain worsens then your doctor may open the cyst to drain it and ease your symptoms
If symptoms are mild these can be watched or treated with sitz baths and estrogen cream therapy. In severe cases surgical excision may be warranted
Most people with urethral prolapse are treated with observation or sitz baths and estrogen cream therapy. Rarely is surgical excision required for the prolapsed tissue.