Savvas Christopher, Araklitis George, Shah Chirag, Robinson Dudley, Cardozo Linda
Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK.
Department of Histopathology, King's College Hospital, SE5 9RS, UK.
Case Rep Womens Health. 2020 Oct 27;28:e00268. doi: 10.1016/j.crwh.2020.e00268. eCollection 2020 Oct.
Urethral caruncles are lesions occurring at the urethral orifice, around the posterior lip of the urethra. They are the most common benign growth of the female urethra. They are often asymptomatic and found incidentally on clinical examination. When symptomatic they commonly present with bleeding. Treatment includes vaginal oestrogens or, failing that, surgical excision. We present an unusual finding after excision of a urethral caruncle.
A patient with a background of stress urinary incontinence had numerous pelvic surgeries, including colposuspension, tension-free vaginal tape (TVT) and Macroplastique (a urethral bulking agent). She developed bleeding from a 3 cm urethral caruncle, which did not improve with vaginal oestrogens. She proceeded to have a surgical excision of the caruncle. Histology revealed a foreign material with surrounding foreign-body-type multinucleate giant cell reaction. The material was compatible with Macroplastique.
This case report describes an unusual and unexpected histological finding. Macroplastique is injected in the urethra, 10-15 mm from the bladder neck. We suspect the caruncle dragged the Macroplastique material out through the urethral meatus. If urethral caruncles are not adequately treated with vaginal oestrogens, surgery should be considered.
尿道肉阜是发生于尿道口、尿道后唇周围的病变。它们是女性尿道最常见的良性肿物。通常无症状，多在临床检查时偶然发现。出现症状时，常见表现为出血。治疗方法包括阴道内使用雌激素，若无效则进行手术切除。我们报告了一例尿道肉阜切除术后的罕见发现。
一名有压力性尿失禁病史的患者接受了多次盆腔手术，包括阴道前壁悬吊术、无张力阴道吊带术（TVT）和Macroplastique（一种尿道填充剂）。她出现了一个3厘米尿道肉阜出血，阴道内使用雌激素后出血未改善。她接受了肉阜的手术切除。组织学检查显示有异物及周围的异物型多核巨细胞反应。该物质与Macroplastique相符。
本病例报告描述了一个罕见且意外的组织学发现。Macroplastique是在距膀胱颈10 - 15毫米处注入尿道的。我们怀疑肉阜将Macroplastique物质通过尿道口拖出。如果阴道内使用雌激素不能有效治疗尿道肉阜，应考虑手术治疗。
