Han Hu, Zhou Xiao-Guang, Fan Dong-Dong, Tian Long, Zhang Xiao-Dong
Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Urology. 2015 Oct;86(4):740-3. doi: 10.1016/j.urology.2015.06.031. Epub 2015 Jul 16.
To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma.
The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration.
The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available.
The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.
描述后尿道血管瘤所致顽固性血精症的罕见病因及有效治疗方法。
记录5例患者的年龄、病程、症状、尿常规、病理结果、免疫组化染色结果及术后并发症。4例患者行经尿道切除术以完全切除病变，1例患者接受经尿道电灼治疗。
5例患者均为中年，平均年龄46.2岁，平均病程8.8年。其血精症的临床特征如下：射精后大量反复出现，与精浆无明显混合，首次射精或晨起第二次排尿后尿液为血尿甚至伴有血凝块，性兴奋后尿道出血，各种积极抗炎治疗效果不显著。膀胱尿道镜检查发现孤立性静脉曲张位于精阜远端与尿道外括约肌之间。经尿道切除后尿道病变以切除曲张病变，并用电灼切除周围组织。CD31和CD34免疫组化染色证实血管形成。最后，4例患者经病理检查结合免疫组化证实存在后尿道血管瘤，但1例患者无可用标本。
对于反复出现顽固性血精症的患者，应考虑后尿道血管瘤的可能性。建议在整个患者服务过程中进行膀胱尿道镜检查，也可采用经尿道切除、电灼或激光切割方法。
