Name of the Procedure:

Excision or fulguration of urethral caruncle. Commonly known as removal or burning of a urethral caruncle.

Summary

This procedure involves the surgical removal or burning off (fulguration) of a urethral caruncle, which is a small, benign growth found at the opening of the urethra.

Purpose

Medical Condition: Urethral caruncle Goals/Expected Outcomes: Relief from symptoms such as pain, bleeding, or discomfort caused by the caruncle, and prevention of recurrence.

Indications

Symptoms: Pain, bleeding, irritation, and discomfort at the urethral opening Conditions: Urethral caruncle that is symptomatic and does not respond to conservative treatment Patient Criteria: Typically postmenopausal women or anyone experiencing troublesome symptoms from the caruncle

Preparation

Pre-Procedure Instructions:

• Fasting may be required if general anesthesia is used
• Adjustments to current medications (e.g., blood thinners) as instructed by the healthcare provider Diagnostic Tests/Assessments:
• Physical examination
• Urinalysis or other relevant tests to check for infections

Procedure Description

1. Anesthesia: Local anesthesia or general anesthesia may be administered.
2. Step-by-Step:
   • Cleansing the urethral area with an antiseptic solution
   • Using surgical instruments, the caruncle is excised (cut out) or fulgurated (burned off) with an electric current or laser
   • Ensuring proper hemostasis (control of bleeding)
   • Closing the incision with sutures if needed
3. Tools/Equipment: Scalpel, electric current device, laser equipment, sutures
4. Sedation Details: Local or general anesthesia depending on the case

Duration

Typically, the procedure lasts about 15 to 30 minutes.

Setting

The procedure is generally performed in an outpatient clinic, surgical center, or hospital.

Personnel

Healthcare Professionals Involved:

• Surgeon or urologist
• Nursing staff
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

Common Risks: Pain, bleeding, urinary tract infection Rare Risks: Scarring, urethral stricture, recurrence of the caruncle

Benefits

Relief from symptoms such as pain and bleeding, improved quality of life, and reduced risk of recurrent infections. Benefits are generally realized shortly after the procedure.

Recovery

Post-Procedure Care:

• Apply prescribed ointments or creams
• Follow pain management instructions
• Maintain good hygiene of the urethral area Expected Recovery Time: Typically, a few days to a week Restrictions: Avoid strenuous activities and sexual intercourse until fully healed Follow-Up: Scheduled for a follow-up appointment to ensure proper healing

Alternatives

Other Treatment Options:

• Observation and monitoring if the caruncle is asymptomatic
• Topical estrogen cream to reduce symptoms Pros/Cons of Alternatives:
• Pros: Non-invasive, less immediate risk
• Cons: May not effectively resolve symptoms for all patients

Patient Experience

During the Procedure: Patient may feel a local anesthetic injection if local anesthesia is used, otherwise the patient will be asleep if general anesthesia is administered. After the Procedure: Mild discomfort, some bleeding, and the need to follow aftercare instructions. Pain managed with prescribed medications or over-the-counter pain relievers. Most patients experience significant relief from symptoms once healed.