Engin KÖLÜKÇÜ, Doğan ATILGAN, Şahin KILIÇ, Yahya DOĞANAY, İlker ETİKAN

Kadınlarda Alt Üriner Sistem Semptomlarının Nadir Bir Nedeni: Üretral Karunkül

Amaç: Üretral karunkül sıklıkla postmenopozal kadınlarda görülen, eksternal üretral meanın posteriorundan köken alan vasküler tümöral bir oluşumdur. Çalışmamızda üretral karunkül tespit edilen 19 kadın hastaya uygulanan üretral karunkül eksizyonun sonuçlarını sunmayı hedefledik.Gereç ve Yöntem: Ocak 2013- Mart 2017 tarihleri arasında üretral karunkül eksizyonu yapılan toplam 19 hastanın; yaşı, medikal öyküsü, maksimum idrar akış hızı, postmiksiyonel rezidü idrar miktarı, patoloji sonuçları, operasyon süresi ve hastanede kalış süreleri incelendi. Tüm hastalar Bristol Kadın Alt Üriner Sistem Semptom İndeksinin (BFLUTS) Türkçe versiyonun ilk 19 sorusu ve Uluslararası Prostat Semptom Skorunun 8. sorusu (IPSS-Q8) ile alt üriner sistem semptomları açısından değerlendirildi. Bulgular: Hastalarının ortalama yaşı 61.21±2.13 yıl idi. Hastaların preoperatif yapılan değerlendirilmesinde maksimum idrar akış hızı, postmiksiyonel rezidü idrar miktarı, BFLUTSve IPSS-Q8ortalama değerleri sırasıyla 7.72±1.82 mL/dk, 43.15±19.43 cc, 40.89±9.01 ve 4,57±1,01 olarak hesaplandı. Tüm hastalara genelveya spinal anestezi altında üretral kitle eksizyonu yapıldı. Tüm hastalarının semptomlarında düzelme oldu ve patoloji sonuçları üretral karunkül olarak rapor edildi. Postoperatif 1. ayda kontrole çağrılan hastalara yapılan değerlendirmede; maksimum idrar akış hızı, ortalama postmiksiyonel rezidü idrar miktarı, BFLUTS ve IPSS-Q8 ortalama değerleri sırasıyla 20,55±5,37 ml/dk, 10,94±8,51 cc, 6.89±4.78ve 1,1±0,93 olarak hesaplandı. Maksimum idrar akış hızı, postmiksiyonel idrar volümü, BFLUTS, IPSS-Q8değer ortalamaları açısından preoperatif ve postoperatif hastalar arasında istatistiksel olarak anlamlı fark izlendi (p≤ 0.0001).Sonuç: Postmenopozal dönemde alt üriner sistem semptomları ile başvuran kadın hastalarda üretral karunkül gibi üretradan kaynaklı patolojilerin olabileceği akılda tutularak ayrıntılı genitoüriner sistem muayenesi yapılmalıdır.

Anahtar Kelimeler:

Alt üriner sistem semptomları, üretra, karunkül

Urethral Caruncle: A Rare Cause of Lower Urinary System Symptoms in Women

Aim: Urethral caruncle that originated from posterior wall of the external urethral meatus is a vascular tumor and frequently seen in postmenopausal women. We aimed to present the results of 19 female patients who underwent urethral caruncle excision in this study.Material and Methods: The data of 19 patients who underwent urethral caruncle excision between January 2013 and March 2017 were reviewed. The patients' age, medical history, maximum urinary flow rate, post-void residual urine volume, pathology results, duration of operation and hospital stay were evaluated. All patients were evaluated for lower urinary tract symptoms with the first 19 questions in the Turkish version of Bristol Female Lower Urinary System Symptom Index (BFLUTS) and the 8th question of the International Prostate Symptom Score (IPSS-Q8).Results: In the preoperative evaluation, the averages of maximum uroflowmetric flow rates, post-void residual urine volumes, BFLUTS, IPSS-Q8 values were calculated as 7.72 ± 1.82 mL / min, 43.15 ± 19.43 cc, 40.89±9.01 and 4.57 ± 1.01 respectively. All patients underwent urethral tumor excision under general or spinal anesthesia. Symptoms of all patients improved and pathology results were reported as urethral caruncles. The averages of maximum uroflowmetric flow rates, post-void residual urine volumes, BFLUTS and IPSS-Q8 values were calculated as 20.55 ± 5.37 ml / min, 10.94 ± 8.51 cc, 6.89±4.78 and 1.1 ± 0. 93 respectively at the postoperative first month control. A statistically significant difference was observed between the preoperative and postoperative avarages of the maximum uroflowmetric flow rates, post-void urine volumes, BFLUTS and IPSS-Q8 values (p ≤ 0.0001).Conclusion: A detailed genitourinary system examination should be performed in postmenopausal females who present with lower urinary tract symptoms, taking into account the possibility of urethral origin pathologies such as urethral caruncle.

Keywords:

Lower urinary tract symptoms, urethra, caruncle,

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1. Tanagho EA, Brant WO, Lue TF. Disorders of the female urethra. In: Tanagho EA, McAnninch JW (eds.) Smith’s General Urology. 17th ed. San Francisco, McGraw-Hill, 2008;638-644.
2. Ricky L.M. In: Urethral Caruncle. Eckler K., editor. 2015.
3. 3.Çimentepe E, Bayrak O, Unsal A, Koç A, Ataoğlu O, Balbay MD. Urethral adenocarcinoma mimicking urethral caruncle. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(1):96-98.
4. Grabstald H. Proceedings: Tumors of the urethra in men and women. Cancer. 1973;32(5):1236-1255
5. Park DS, Cho TW; Simple solution for urethral caruncle. J Urol. 2004;172:1884-1885.
6. Ozkurkcugil C, Ozkan L, Tarcan T. The effect of asymptomatic urethral caruncle on micturition in women with urinary incontinence. Korean J Urol. 2010;51:257-259.
7. Sajadi KP, Kim ED. Urethral Caruncle treatment & Management emedicine. 2011.
8. Gökkaya CS, Öztekin ÇV, Doluoğlu ÖG, Güzel Ö, Erşahin V, Özden C et al. Validation of Turkish Version of Bristol Female Lower Urinary Tract Symptom Index. Journal of Clinical and Analytical Medicine. 2012;3(4): 415-418
9. Fourcade RO, Theret N, Taieb C. Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries. BJU Int. 2008;101:1111–1118.
10. Kelly, H. A. Gynecology, D. Appleton Co., New York, 1928;815.
11. Sajadi K P, Kim E D. Urethral Caruncle treatment & Management Emedicine. 2011.
12. Campbell MF. Radiologic diagnosis of urinary tract tumors in infants and children. Radiology. 1950;54:646–658.
13. Pugh RC. Systemic Pathology. 3rd edition. Philadelphia, PA: W.B. Saunders Company; 1992. The Kidneys: The Urinary Tract;745.
14. Eilber KS. Benign cystic lesions of the vagina and vulva. In: Raz S, Rodriguez LV, editors. Female urology. 3rd ed. Philadelphia: Saunders 2008; 877-884
15. Türkeri L, Simšek F, Akdaş A. Urethral caruncle in an unusual location occurring in prepubertal girl. Eur Urol. 1989;16:153-154
16. Dong PS, Cho TW. Simple solution for urethral caruncle. J Urol. 2004;172:1884-1885.
17. Rovner ES. Bladder and Urethral diverticula. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds.) Campbell-Walsh Urology 9th ed. Philadelphia: Saunders. 2007;2361-2391.
18. McCrery RJ, Appell RA. Bladder outlet obstruction in women: iatrogenic, anatomic, and neurogenic. Curr Urol Rep. 2006;7:363-369.
19. Omar A, Thomas A, Thompso I. Primary urethral transitional cell carcinoma presenting as a urethral caruncle. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1227-1228.
20. Marshall FC, Uson AC, Melicow MM. Neoplasma and caruncles of the female urethra. Surg Gynecol Obstet. 1960;110:723–733.
21. Nakamoto T, Inoue Y,Ueki T, Niimi N, Iwasaki Y. ; Primaryamelanotic malignant melanoma of the female urethra. Int JUrol. 2007;14(2):153-155.
22. Singh I,HemalAK; Primaryurethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity! Int Urol Nephrol. 2002;34(1):101-103.
23. Shim JS, Oh MM, Lee JG, Bae JH;Anterior urethrectomyfor primarycarcinoma of the female urethra mimicking a urethral caruncle. IntNeurourol J. 2013;17(4):197-199.
24. Kaneko G, Nishimoto K, Ogata K, Uchida A. A case of intraepithelial squamous cell carcinoma arising from urethral caruncle. Can Urol Assoc J. 2011;5(1):14-16.
25. Saroha V, Dhingra KK, Gupta P, Khurana N;Urethral leiomyoma mimicking a caruncle. Taiwan J Obstet Gynecol. 2010;49(4):523-524.
26. Atalay AC, Karaman MI, Basak T, Utkan G, Ergenekon E. Non-Hodgkin's lymphoma of the female urethra presenting as a caruncle. Int Urol Nephrol. 1998;30(5):609-610.
27. Khatib RA, Khalil AM, Tawil AN, Shamseddine AI, Kaspar HG, Suidan FJ. Non-Hodgkin’s lymphoma presenting as a urethral caruncle. 1993;50(3):389–393.
28. Willett GD, Lack EE. Periurethral colonic-type polyp simulating urethralcaruncle. A case report. J Reprod Med. 1990;35:1017-1018
29. Urakami S, Igawa M, Shiina H, Ishibe T. Urethral caruncle with coexistence of intestinal heterotopia: A case report. Int Urol Nephrol. 1997;29(3):341-344.
30. Becker LE. Urethral caruncle: A herald lesion for distal urethral stenosis? J Natl Med Assoc. 1975;67:228-230
31. Fernandez AM, De Castro BF, Cortes AL. Female urethral caruncle. A thrombosis of the dorsal venous complex? Actas Urol Esp. 1998;22:443-445
32. KodzoA, VenyoG. Urethral Caruncles: A Review of the Literature Web med central Urology. 2012;3(6):WMC003454.