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Vulva and Introitus

Biopsy of the Vulva

Excision of Urethral Caruncle

Bartholin's Gland Cyst Marsupialization

Excision of Vulvar Skin, with Split-Thickness Skin Graft

Bartholin's Gland Excision

Vaginal Outlet
Stenosis Repair

Closure of Wide Local Excision of the Vulva

Wide Local Excision
of the Vulva, With Primary Closure or Z-plasty Flap

Alcohol Injection
of the Vulva

Cortisone Injection
of the Vulva

Merring Operation

Simple Vulvectomy

Excision of the
Vulva by the Loop Electrical Excision Procedure (LEEP)

Excision of
Vestibular Adenitis

Release of Labial Fusion


Excision Of Hypertrophied Clitoris

Excision of Urethral Caruncle

Urethral caruncles are frequently associated with atrophic genital epithelium in elderly patients. They can become a source of chronic hematuria, infection, and urethritis. When medical therapy with estrogen suppositories and cream does not adequately clear the lesion, surgical excision is indicated.

The lesion is excised, and normal urethral mucosa is sutured to the epithelium of the vestibule. 

Physiologic Changes. The removal of the inflamed granulation tissue eliminates a cause of chronic infection and bleeding.
Points of Caution. The operation can frequently be bloody and, in general, should be performed in an operating room rather than in an office or clinic.

The need for Foley catheter drainage following removal of the lesion may be necessary. The application of estrogen cream reduces the risk of recurrent caruncles.


The patient is placed in the dorsal lithotomy position, and appropriate anesthesia is administered (general, regional, or local). The vulva and perineum are prepped.

The caruncle is grasped with an Allis clamp and retracted slightly forward. A scalpel is used to excise some of the vestibular epithelium and to transect the urethra proximal to the caruncle.

The specimen is removed, and the urethral mucosa as well as the vestibular epithelium is exposed.

The urethral mucosa is closed to the vestibular epithelium with interrupted 3-0 synthetic absorbable sutures.

The urethral mucosa is sutured to the epithelium of the vestibule.


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