Urethral caruncles are common in clinical practice, but some may harbor rare pathological component. In addition to relieve the urination complaints of the patient, adequate excisional surgery and urethral reconstruction are crucial for disease treatment. Careful planning of surgical treatment in advance is crucial in eliminating the obstructed urethra and the individualized treatment.

We present the case of a 79-year-old female who presented with persistent spreading of urine stream and off and on hematuria for months. The clinical picture of the urethra was compatible with urethral caruncle which was located at the posterior aspect of the urethra with soft and well margined pink appearance. She received cystoscopic evaluation and open excision tumor and reconstruction of the urethra surgery with smooth course postoperatively. Her family history or comorbid medical history were not contributory.

The pathology showed adenocarcinoma component in the villotubular adenoma of the urethra with surgical margin free. After surgery CT imaging and staging showed no other metastatic signs. The patient and family chose conservative follow-up. The patient reported complete resolution of symptoms at the 2-year follow-up. The table (see the attchment) summarized female cases reports in recent ten years and surgical excision was the major procedure to treat the lesions in the female patients.

We present this rare local malignancy of urethral meatus with successful management and follow-up. This case presents the importance of surgical management of a benign looking of urethral mass. Even the benign looking of the gross appearance of the lesions in older female patients, surgical intervention is a feasible recommendation for the patient. It is important of considering surgical management for urethral masses that appear benign, especially in older female patients.