Kang Dong Hyuk, Lee Joo Yong, Jung Dae Chul, Oh Young Taik, Cho Eun Suk, Park Sung Yoon, Lee Ki Soo, Cho Kang Su
Department of Urology, Inha University School of Medicine, Incheon, Republic of Korea.
Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Urology. 2018 May;115:112-118. doi: 10.1016/j.urology.2018.01.041. Epub 2018 Feb 9.
To review the tertiary referral hospital experiences of men presenting with painless postcoital gross hematuria (PCGH) and suggest a management algorithm.
We reviewed clinical data from 19 male patients who first visited a clinic because of PCGH between 2009 and 2016. The patients were evaluated according to our tentative management algorithm for painless PCGH. First, a general workup for painless gross hematuria (GH) was performed. If the cause of the PCGH was not identified, a vascular workup of the pelvic vasculatures for PCGH was performed, including transrectal and penile ultrasonography with Doppler study. Pelvic angiography and subsequent angioembolization were recommended at the physician's discretion.
The median age of the patients was 47 (range: 30-67) years. The tentative management algorithm led to no abnormal findings in 7 patients and identified urologic malignancies in 2 patients. Urethrocystoscopy revealed urethral hemangioma in 3 patients. Doppler ultrasonography revealed pelvic varicosities in 3 patients, complicated cyst of Cowper glands in 1 patient, and pelvic arteriovenous malformation in 3 patients. Pelvic angiography was recommended for the 3 patients with pelvic arteriovenous malformation, and 2 of those patients were successfully treated by angioembolization.
The clinical approach to painless PCGH should be different from that of painless GH. Both the general and the vascular workup for the pelvic vasculatures for painless GH are mandatory for the evaluation of patients with painless PCGH.
回顾三级转诊医院中出现无痛性性交后肉眼血尿（PCGH）男性患者的诊疗经历，并提出一种管理算法。
我们回顾了2009年至2016年间因PCGH首次就诊于门诊的19例男性患者的临床资料。根据我们针对无痛性PCGH的初步管理算法对患者进行评估。首先，对无痛性肉眼血尿（GH）进行全面检查。如果未确定PCGH的病因，则对盆腔血管进行PCGH的血管检查，包括经直肠和阴茎超声检查及多普勒研究。根据医生的判断建议进行盆腔血管造影及随后的血管栓塞术。
患者的中位年龄为47岁（范围：30 - 67岁）。初步管理算法在7例患者中未发现异常，在2例患者中发现了泌尿系统恶性肿瘤。尿道膀胱镜检查在3例患者中发现尿道血管瘤。多普勒超声检查在3例患者中发现盆腔静脉曲张，1例患者发现考珀腺复杂囊肿，3例患者发现盆腔动静脉畸形。对3例盆腔动静脉畸形患者建议进行盆腔血管造影，其中2例患者通过血管栓塞术成功治疗。
无痛性PCGH的临床处理方法应与无痛性GH不同。对无痛性GH进行盆腔血管的全面和血管检查对于评估无痛性PCGH患者都是必要的。
