Posterior urethral hemangioma: one of the unknown causes of hematuria and/or hematospermia.

OBJECTIVES: 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.
METHODS: A total of 20 patients were evaluated for symptoms, diagnosis, histologic findings, and treatment. In addition, the published data were reviewed.
RESULTS: 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.
CONCLUSIONS: 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.