Urethral caruncles are benign, distal urethral lesions that are most commonly found in postmenopausal women, although a case of urethral caruncle has also been described in a male. Urethral caruncles resemble various urethral lesions, including carcinoma. The differential diagnoses of urethral caruncle include the following:

• Urethral diverticulum
• Urethral prolapse
• Urethral carcinoma
• Periurethral gland abscesses

Most urethral caruncles can be treated conservatively with warm sitz baths and vaginal estrogen replacement. Surgical intervention may be indicated for patients with larger symptomatic lesions and for those with uncertain diagnoses. Possible indications for excisional biopsy include the following:

• Induration
• Failure to respond to conservative therapy
• Atypical appearance
• Growth over time