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doi: 10.25005/2074-0581-2020-22-3-461-470
BENIGN URETHRAL NEOPLASMS IN WOMEN

S.Kh. Al-Shukri1, M.N. Slesarevskaya2,3, I.V. Kuzmin1

1Department of Urology, Academician I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
2Scientific Research Center of Urology, Research Institute of Surgery and Emergency Medicine, Academician I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
3Clinical Department of Laser Medicine, Academician I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation

The review article presents current data on the diagnosis and treatment of benign urethral neoplasms (BUN) in women. BUNs are common diseases, manifest with express clinical symptoms and significantly impair the quality of life of patients. The main manifestations of BUN are urination disorders, pathological discharge from the urethra, pain, dyspareunia, as well as the presence of a palpable formation in the urethra. Risk factors for the occurrence of BUN include recurrent lower urinary tract infections, impaired blood flow in the urethra, trauma to the external opening of the urethra, hypoestrogenemia, which contributes to urogenital atrophy and hyperplastic processes in the urinary tract. Macroscopic signs, symptoms and clinical course of fibroepithelial polyps of the urethra, urethral caruncles, urethral condylomas, non-epithelial benign tumors of the urethra (leiomyomas, hemangiomas and others) are described. The detailed diagnostic methods of BUN are presented, and special attention is paid to differential diagnosis with malignant tumors of the urethra. It is noted that the final diagnosis is made on the basis of histological examination. The main treatment for BUN is surgical. The choice of surgical treatment method is determined by the type of benign neoplasm and the nature of the clinical course. The modern methods of surgical treatment of BUN are described in detail, including laser ablation.

Keywords: Benign urethral tumor, urethral polyp , caruncle, leiomyoma, laser ablation.

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References
  1. Kan DV. Rukovodstvo po akusherskoy i ginekologicheskoy urologii [Manual to obstetric and gynecological urology]. 2nd ed. Moscow, USSR: Meditsina; 1986. 488 p.
  2. Jenner JC. Case of an excrescence in the urethra of a female patient successfully treated. Lond Med J. 1786;7(Pt 2):160-2.
  3. Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, USA: Elsevier Science; 2009. 1472 p.
  4. Heller D. Lesions of the female urethra: A review. J Gynecol Surg. 2015;31(4):189-97. Available from: https://doi.org/10.1089/gyn.2014.0125
  5. Kumar P, Mehrotra N. Jeffcoate’s Principles of Gynaecology. 7th ed. New Delhi, India: Jaypee Brothers Medical Publishers Ltd; 2008. 976 p.
  6. Khokhlachyov NP. Dobrokachestvennye opukholi zhenskoy uretry [Benign tumors of the female urethra]. Moscow; USSR: Izdatel’stvo 1 MMI; 1972. 18 p.
  7. Clark J, Olson L, Kujawa M. A review of the diagnosis and management of urethral caruncles. Urology News. 2017;22(1):28-9.
  8. Conces MR, Williamson SR, Montironi R, Lopez-Beltran A, Scarpelli M, Cheng L. Urethral caruncle: clinicopathologic features of 41 cases. Hum Pathol. 2012;43(9):1400-4. Available from: https://doi.org/10.1016/j.humpath. 2011.10.015
  9. Kuzmin IV, Al-Shukri SKh, Slesarevskaya MN. Lechenie i profilaktika retsidiviruyushcheн infektsii nizhnikh mochevykh puteн u zhenshchin [Treatment and prophylaxis of the lower urinary tract recurrent infections in women]. Urologicheskie vedomosti. 2019;9(2):5-10. Available from: https://doi. org/10.17816/uroved925-10
  10. Bakarev MA, Neymark AI, Lushnikova EL, Pichigina AK, Yakovlev AV. Patomorfologicheskiy analiz i otsenka mikrotsirkulyatsii polipov naruzhnogo otverstiya uretry u zhenshchin [Pathomorphological analysis and evaluation of microcirculation in polyps of the external urethral meatus in women]. Byulleten’ eksperimental’noy biologii i meditsiny. 2015;160(7):119-125.
  11. Battaglia C, Battaglia B, Ramacieri A, Paradisi R, Venturoli S. Recurrent postcoital hematuria. A case of fibroepithelial urethral polyp in an adult female. J Sex Med. 2011;8(2):612-6. Available from: https://doi.org/10.1111/j.1743- 6109.2010.02006.x
  12. Oxenius I, Vacirca FA. Rare case of fibroepithelial polyp of the proximal urethra in a young woman. Urologia. 2008;75(3):193-4
  13. Neymark AI, Yakovlev AV, Nepomnyashchikh LM. Kliniko-morfologicheskie osobennosti polipov naruzhnogo otverstiya uretry u zhenshchin [Clinical and morphological features of female urethral meatus polyps]. Urologiya. 2015;3:33-8.
  14. Neymark AI, Bakarev MA, Lushnikova EL, Pichigina AK, Yakovlev AV. Kliniko-morfologicheskie osobennosti polipov uretry u zhenshchin na fone urogenital’noy infektsii [Clinical and morphological features of urethral polyps in women with urogenital infection]. Fundamental’nye issledovaniya. 2015;1:1194-8.
  15. Kuppusami K, Moors DE. Fibrous polyp of the verumontanum. Can J Surg. 1968;11(3):388-91.
  16. Rinia AB, Kostamo K, Ebbens FA, van Drunen СМ, Fokkens WJ. Nasal polyposis: A cellular-based approach to answering questions. Allergy. 2007;62(4):348- 58. Available from: https://doi.org/10.1111/j.1398-9995.2007.01323.x
  17. Eyden B. The myofibroblast: phenotypic characterization as a prerequisite to understanding its functions in translational medicine. J Cell Mol Med. 2008;12(1):22-37. Available from: https://doi.org/10.1111/j.1582- 4934.2007.00213.x
  18. Petersen RO, Sesterhenn IA, Davis CJ. Urologic Pathology. 3rd ed. Philadelphia, USA: Lippincott Williams & Wilkins, 2009. 636 p.
  19. Yakovlev AV, Neymark AI, Taranina TS, Kondratyeva YS, Razdorskayа MV. Klinika i patomorfologiya polipov uretry u zhenshchin pri ureaplazmennoy infektsii [Clinical features and pathomorphology of urethral polyps in women with ureaplasma infection]. Ural’skiy meditsinskiy zhurnal. 2012;1:90-3.
  20. Lapiy GA, Molodykh OP, Bakarev MA, Yakovlev AV, Neymark AI. Ul’trastrukturnyy analiz polipov naruzhnogo otverstiya uretry na fone urogenital’noy infektsii [Ultrastructural analysis of urethral polyps against the background of urogenital infection]. Byulleten’ eksperimental’noy biologii i meditsiny. 2019;167(6): 757-62.
  21. Williams TR, Wagner BJ, Corse WR, Vestevich JC. Fibroepithelial polyps of the urinary tract. Abdom Imaging. 2002;27(2):217-21.Available from: https:// doi.org/10.1007/s00261-001-0066-z
  22. Ferrier PA. Urethral caruncle. Cal West Med. 1926;24(4):500-1.
  23. Bell ET. A Textbook of Pathology. 6th ed. Philadelphia, USA: Lea & Febiger; 1956. 1028 p.
  24. Hall ME, Oyesanya T, Cameron AP. Results of surgical excision of urethral prolapse in symptomatic patients. Neurourol Urodyn. 2017;36(8):2049-55. Available from: https://doi.org/10.1002/nau.23232
  25. Shevchuk DV. Redkiy sluchay uretral’nogo karunkula, oslozhnyonnogo nervno- myshechnoy disfunktsiey mochevogo puzyrya, u 9-letney devochki [A rare case of urethral caruncle complicated with neuromuscular bladder dysfunction in a 9-year-old girl]. Khirurgiya detskogo vazrasta. 2016;1-2:97-9.
  26. Kim KK, Sin DY, Park HW. Urethral caruncle occurring in a young girl – A case report. J Korean Med Sci. 1993;8(2):160-1. Available from: https://doi. org/10.3346/jkms.1993.8.2.160
  27. Chiba M, Toki A, Sugiyama A, Suganuma R, Osawa S, Ishii R, et al. Urethral caruncle in a 9-year-old girl: a case report and review of the literature. J Med Case Rep. 2015;9:71. Available from: https://doi.org/10.1186/s13256-015- 0518-7
  28. Williamson SR, Scarpelli M, Lopez-Beltran A, Montironi R, Conces MR, Cheng L. Urethral caruncle: a lesion related to IgG4-associated sclerosing disease? J Clin Pathol. 2013;66(7):559-62. Available from: https://doi.org/10.1136/ jclinpath-2012-201218
  29. Matsuda KM, Kishi Y, Chuman K, Hino H, Kagami S. Urethral caruncle complicated by urinary tract infection. J Dermatol. 2019;46(10):e383-e385. Available from: https://doi.org/10.1111/1346-8138.14912
  30. Singh I, Hemal AK. Primary urethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity! Int Urol Nephrol. 2002;34(1):101-3. Available from: https://doi.org/10.1023/a:1021319231389
  31. Novak E, Novak ER, Woodruff JD. Novak’s Gynecologic and Obstetric Pathology. 6th ed. Philadelphia, USA: Saunders; 1967. 696 p.
  32. 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):E14-6. Available from: https://doi.org/10.5489/cuaj.10027
  33. Armengaud C, Hermieu JF, Deffieux X. Thrombosed urethral caruncle following pelvic organ prolapse surgery. Prog Urol. 2019;29(7):391-2. Available from: https://doi.org/10.1016/j.purol.2019.04.010
  34. Bosch FX, Broker TR, Forman D, Moscicki AB, Gillison ML, Doorbar J, et al. Comprehensive control of human papillomavirus infections and related diseases. Vaccine. 2013;31(Suppl 7):G1-31. Available from: https://doi. org/10.1016/j.vaccine.2013.10.002
  35. Trottier H, Mayrand MH, Coutlee F, Monnier P, Laporte L, Niyibizi J, et al. Human papillomavirus (HPV) perinatal transmission and risk of HPV persistence among children: Design, methods and preliminary results of the HERITAGE study. Papillomavirus Res. 2016;2:145-52. Available from: https:// doi.org/10.1016/j.pvr.2016.07.001
  36. Minkina OV. Genital’naya papillomavirusnaya infektsiya i vozmozhnost’ eyo profilaktiki [Genital papillomavirus infection and the possibility of its prevention]. Sovremennye problemy dermatovenerologii, immunologii i vrachebnoy kosmetologii. 2007;1(3):3-10.
  37. Ozel B, Ballard C. Urethral and paraurethral leiomyomas in the female patient. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(1):93-5. https://doi. org/10.1007/s00192-005-1316-3
  38. Navarro JM, Martínez BB, Talavera RJ, Robayna AA. Recurrence of urethral leiomyoma: A case report. Urol Case Rep.2019;26:100968. Available from: https://doi.org/10.1016/j.eucr.2019.100968
  39. Streltsova OS, Kachalina OV, Yunusova KE, Molvi M, Kiselyova EB. Leyomioma uretry [Urethral leiomyoma]. Urologiya. 2018;1:129-33. Available from: https://doi.org/10.18565/urol.2018.1.129-133
  40. Slaoui A, Lasri A, Karmouni T, Elkhader K, Koutani A, Attaya AI. Leiomyoma: a case report of a rare benign tumor of the female urethra. Pan Afr Med J. 2015;22:111. Available from: https://doi.org/10.11604/ pamj.2015.22.111.7785
  41. Fedelini P, Chiancone F, Fedelini M, Fabiano M, Persico F, Di Lorenzo D, et al. A very large leiomyoma of the urethra: A case report. Urologia. 2018;85(2):79- 82. Available from: https://doi.org/10.5301/uro.5000223
  42. Regragui S, Slaoui A, Karmouni T, El Khader K, Koutani A, Attya AI. Urethral hemangioma: case report and review of the literature. Pan Afr Med J. 2016;23:96. Available from: https://doi.org/10.11604/pamj.2016.23.96.8700
  43. Slesarevskaya MN, Al-Shukri SKh, Sokolov AV, Kuzmin IV. Klinicheskoe techenie i khirurgicheskoe lechenie parauretral’nykh kistoznykh obrazovaniy u zhenshchin [Clinical course and surgical treatment of paraurethral cysts in women]. Urologicheskie vedomosti. 2019;9(4):5-10]. Available from: https:// doi.org/10.17816/uroved945-10
  44. Touijer AK, Dalbagni G. Role of voided urine cytology in diagnosing primary urethral carcinoma. Urology. 2004;63(1):33-5. Available from: https://doi. org/10.1016/j.urology.2003.08.007
  45. Siegelman ES, Banner MP, Ramchandani P, Schnall MD. Multicoil MR imaging of symptomatic female urethral and periurethral disease. Radiographics. 1997;17(2):349-65. Available from: https://doi.org/10.1148/radiographics. 17.2.9084077
  46. Minaev VP. Lazernye meditsinskie sistemy i meditsinskie tekhnologii na ikh osnove: Uchebnoe posobie [Laser medical systems and medical technologies based on them: Textbook]. Dolgoprudnyy, RF: Izdatel’skiy dom «Intellekt»; 2017. 352 p.
  47. Slesarevskaya MN, Ponomaryova YuA, Sozdanov PV, Tyurin AG, Sychyova AM, Kuzmin IV. Diagnostika i khirurgicheskoe lechenie krupnoy parauretral’noy kisty [Surgical treatment of a large paraurethral cyst]. Urologicheskie vedomosti. 2020;10(1):75-80. Available from: https://doi.org/10.17816/ uroved10175-8
  48. Al-Shukri SKh, Kuzmin IV, Slesarevskaya MN, Sokolov AV. Opyt lazernoy ablyatsii parauretral’nykh kistoznykh obrazovaniy uretry u zhenshchin [Laser ablation of paraurethral cysts in the urethra in women]. Lazernaya meditsina. 2019;23(S3):63.
  49. Verma V, Pradhan A. Management of urethral caruncle – a systematic review of the current literature. Eur J Obstet Gynecol Reprod Biol. 2020;248:5-8. Available from: https://doi.org/10.1016/j.ejogrb.2020.03.001
  50. Al-Shukri SKh, Kuzmin IV, Slesarevskaya MN. Kombinirovannoe lechenie genital’noy papillomavirusnoy infektsii u muzhchin [Combined treatment of genital human papillomavirus infection in men]. Urologiya. 2015;6:35-9.

Authors' information:

Al-Shukri Salman Khasunovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Urology, Academician I.P. Pavlov First Saint Petersburg State Medical University
Researcher ID: R-4982-2017
Scopus ID: 6601962854
ORCID ID: 0000-0002-4857-0542
SPIN: 2041-8837
Author ID: 85626
E-mail: alshukri@mail.ru

Slesarevskaya Margarita Nikolaevna
Candidate of Medical Sciences, Senior Researcher, Scientific Research Center of Urology, Research Institute of Surgery and Emergency Medicine; Urologist, Clinical Department of Laser Medicine, Academician I.P. Pavlov First Saint Petersburg State Medical University
Researcher ID: R-2614-2017
Scopus ID: 57196117211
ORCID ID: 0000-0002-4911-6018
SPIN: 9602-7775
Author ID: 437914
E-mail: mns-1971@yandex.ru

Kuzmin Igor Valentinovich
Doctor of Medical Sciences, Professor of the Department of Urology, Academician I.P. Pavlov First Saint Petersburg State Medical University
Researcher ID: R-1473-2017
Scopus ID: 7003925400
ORCID ID: 0000-0002-7724-7832
SPIN: 2684-4070
Author ID: 359536
E-mail: kuzminigor@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Kuzmin Igor Valentinovich
Doctor of Medical Sciences, Professor of the Department of Urology, Academician I.P. Pavlov First Saint Petersburg State Medical University

197022, Russian Federation, Saint Petersburg, Lva Tolstogo str., 17

Tel.: +7 (812) 3386936

E-mail: kuzminigor@mail.ru

Materials on the topic:
  1. VARIANT ANATOMY OF THE BRACHIAL PLEXUS
  2. MEASUREMENT OF LUNG DEAD SPACE VOLUME BY CAPNOVOLUMETRY

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