From: Proceedings 10th World Congress of Cryosurgery
Cryosurgery of urethral caruncle and prolapse

November 1998
JC Almeida Goncalves and JM Pires Teixeira
Departments of Dermatology and Gynaecology, District Hospital, Santardin, Portugal

Urethral caruncle and prolapse are extrusions of the urethral mucosa. The first is a sessile or pedunculated mucosal pedicle on the lower limit of the urethral meatus; the second is an all-around protrusion of the mucosa with a rose-like shape. They are frequent in postmenopausal women. Sometimes asymptomatic, they can cause mild local discomfort, such as pruritus, urination disturbances and slight hemorrhaging. They are rarely complicated with thrombosis, but, then, become very painful. The usual treatment for both situations is conventional surgery, but the procedure is delicate, requiring hospitalization, operating theatre, local or general anesthesia, and the catheterization for a few days.

We have treated 50 women, 29 suffering from caruncle and 21 from urethral prolapse with mild symptoms, on an outpatient basis. The technique is very simple and takes very little time to perform: in the beginning of our experience we used local anesthesia induced by spraying the mucous membrane with lydocaine solution. Later on, we verified that cryosurgery of these lesions is not painful. To treat the caruncle, we hold it with a small forceps and applied on it a thin cryoprobe; cooled by liquid nitrogen. To treat the prolapse, the cryoprobe is applied on its center. In both cases, the treatment is discontinued when the whole lesion, including its base, is frozen without safety margin.

A single freeze-thaw cycle per session is carried out, with no temperature or impedance monitoring. During the following days, a discreet haematic exudate or slight hemorrhage and edema will occur, which, however, will not affect urination. In the beginning we were very prudent. Fearing urethral stenosis, we used to partially freeze the caruncle or the prolapse in two or more successive procedures. As no urethral stenosis was ever observed, we realized that we could be bolder. At present, we always try to treat every case with only one cryosurgical procedure. We carried out two or more procedures, only if the first proved insufficient. Six patients presented with thrombosis of the caruncle, with lesions measuring between I and 2 cm. These were dark, bleeding and very painful. These cases were first treated medically. Four to six weeks later, after complete resolution of the thrombosis, cryosurgery of the remaining lesion was carried out. Previous biopsy was carried out on two patients. Forty-two patients were cured, the majority of whom with one single treatment. In two others, the condition improved, but the patients were satisfied with the result and refused any further treatment. Four lesions recurred: three were again treated by the same method and definitively cured; the fourth, a voluminous recurrence, was treated surgically. Two patients had hemorrhage and one had moderate and transitional difficulty to urinate. The advantages of the method are obvious: it is efficient, comfortable, and painless. It does not require hospitalization, anesthesia, operating room, or catheterization. This method is very simple, takes very little time and is quite inexpensive.


Cryo-Forum Index