Ikeda Junichi, Taniguchi Hisanori, Inoue Monta, Masuo Yuki, Nakamoto Takahiro, Uchida Katsunori, Yanishi Masaaki, Kinoshita Hidefumi
Urology and Andrology, Kansai Medical University, Hirakata, JPN.
Pathology, Kansai Medical University, Hirakata, JPN.
Cureus. 2025 Apr 22;17(4):e82791. doi: 10.7759/cureus.82791. eCollection 2025 Apr.
A 49-year-old man consulted his previous doctor, reporting occasional episodes of macroscopic hematuria after an erection. Cystourethroscopy under artificial erection revealed findings suggestive of a hemangioma in the membranous urethra. The frequency of hematuria decreased with the use of 5α-reductase inhibitors (5ARIs) and hemostatic agents but subsequently increased, leading to the patient's referral to our department for further examination and treatment. Under general anesthesia and in the lithotomy position, an artificial erection was induced by injecting 80 mg of papaverine hydrochloride into the corpus cavernosum, and a cystourethroscopy was performed using white light. A mass was identified extending from the distal verumontanum of the prostatic urethra to the membranous urethra. Due to the proximity of the hemangioma to the urethral sphincter, narrow-band imaging (NBI) was used for precise identification, followed by biopsy and coagulation. The histopathological findings were a cavernous hemangioma. The patient experienced no recurrence of hematuria or urinary incontinence. Urethral hemangioma, a known cause of posterectile hematuria, can be effectively diagnosed and treated via endoscopic observation during induced erection. In this case, NBI facilitated the accurate visualization of the hemangioma, enabling surgical resection without postoperative complications such as urinary incontinence, despite the mass's proximity to the urethral sphincter. NBI improves the visibility of the mass and may contribute to more accurate and safer treatment of urethral hemangiomas.
一名49岁男性咨询其之前的医生，报告称勃起后偶尔出现肉眼血尿。人工勃起状态下的膀胱尿道镜检查发现提示膜部尿道存在血管瘤。使用5α还原酶抑制剂（5ARIs）和止血剂后，血尿频率有所下降，但随后又增加，导致患者转诊至我院进行进一步检查和治疗。在全身麻醉及截石位下，向海绵体内注射80mg盐酸罂粟碱诱导人工勃起，并使用白光进行膀胱尿道镜检查。发现一个肿物从前列腺尿道的远端精阜延伸至膜部尿道。由于血管瘤靠近尿道括约肌，使用窄带成像（NBI）进行精确识别，随后进行活检和凝固治疗。组织病理学检查结果为海绵状血管瘤。患者未出现血尿复发或尿失禁。尿道血管瘤是勃起后血尿的已知病因，可通过诱导勃起时的内镜观察进行有效诊断和治疗。在本病例中，NBI有助于清晰观察血管瘤，尽管肿物靠近尿道括约肌，但仍能进行手术切除且无尿失禁等术后并发症。NBI提高了肿物的可视性，可能有助于更准确、安全地治疗尿道血管瘤。
