Primary urethral tuberculosis associated with a caruncle is an extremely rare entity and ours is the second such case to be reported. A middle-aged woman presented with symptoms of frequency dysuria syndrome for the last 2 years. Local examination and cystoscopy revealed localized parurethral induration, tenderness and a urethral caruncle with chronic obliterative urethritis. Transvaginal ultrasound revealed a solid lesion arising from the posterior urethral wall. Excision of the caruncle and transurethral resection of the paraurethral mass lesion revealed chronic granulomatous inflammation with chronic urethritis and fibrocollagenous tissue. The literature regarding the genesis of urethral caruncle, the underlying conditions, its differential diagnosis and management has been reviewed.