Posterior Urethral Hemangioma: One of the Unknown Causes of Hematuria and/or Hematospermia

Abstract

Posterior urethral hemangioma used to be considered extremely rare. However, urologists sometimes encounter patients who present with unknown hematospermia and/or postejaculation hematuria or posterection hematuria. We evaluated the symptoms, diagnosis, and treatment and reviewed the published data. A total of 20 patients were evaluated for symptoms, diagnosis, histologic findings, and treatment. In addition, the published data were reviewed. The typical symptoms were hematospermia and/or postejaculation hematuria. Of the 20 patients, 6 (30%) had urinary retention with blood clots, as did 6 patients reported in the published studies. Other symptoms included initial hematuria and/or urethral bleeding after erection in 5 patients (25%). The remaining 9 patients (45%) were asymptomatic and posterior urethral hemangioma was discovered by chance at urethroscopy, although the patients had had microscopic hematuria. Typically, cystourethroscopy revealed an approximately 5-mm, solitary sessile lesion that appeared as a varicosities on the membranous urethra between the verumontanum and external sphincter. Endoscopy immediately after ejaculation or erection, together with a reduction in the flow of irrigant, during cystoscopy was helpful in the discovery of the condition. Transrectal power Doppler ultrasonography was also helpful to allow discovery by minimally invasive means. A strong blood flow site in the urethra near the apex of the prostate was observed. The lesion was resected endoscopically, and fulguration was attempted. Histologic examination revealed cavernous hemangioma. Posterior urethral hemangioma is more common than the published data suggest. Urologists should consider the possibility of urethral hemangioma when encountering a patient with hematospermia and/or postejaculation or posterection hematuria.