Urethral Venous Malformation: An Unusual Cause of Recurrent Post-Coital Gross Haematuria in Association with Haematospermia

Abstract

Ann RC oll Surg Engl 2009; 91:5 32-534 532Bleeding per urethram is ac ommon urological symptom which prompts urgent investigation, aimed primarily at excluding malignancy.T he differential diagnosis in these patients is considerable. We present three cases of urethral bleeding associated with post-coital ejaculation that was found to be caused by urethral venous malformations, a condition that is rare but probably under-reported. Patients and MethodsThe case notesofthree patients who wereidentified as suffering from post-coital urethral bleeding were reviewed. Due to the rarity of the disease and the lack of standardisation in the diagnosisa nd treatment, personal communication withe ach surgeon was necessary for am ore accurate descriptiono ft he intra-operativefindings and details of the surgical treatment. A search and reviewo ft he literature publishedi nE nglish was performed using the PubMed database. ResultsThe three patients in this series were treated by three different urological surgeons, all practising in the same unit. Cases are reported both separately and in comparison (Table 1). Case report 1A5 8-year-old man represented to the department of urology in 2007 with ah istory of haematospermia and haematuria spanning 20 years. The patient reported that episodes of haematospermia and haematuria were provoked by ejaculation. He was first investigated for frank haematuria 18 years previously when it was reported that there was no abnormality of the urinary tract. He was re-investigated for haematuria 10 years later when large 'varicose veins' were noted in the bulbar and membranous urethra, coursing over the external sphincter muscle. Three years previously, he was again referred complaining of haematuria. On this occasion, af lexible cystoscopy was reported as normal. Over the next 2y ears, the patient was admitted to hospital on three occasions with further episodes of heavy haematuria and the passage of clots. Investigations including an intravenous urogram, renal/pelvic ultrasound scan and magnetic resonance imaging (MRI) of the pelvis were reported as normal. His most recent cystourethroscopy, however,demonstrated large, abnormal branching veins in the bulbar urethra (Fig. 1) on either side of the verumontanum and around the bladder neck. In addition, within the bladder there were abnormal sub-mucosal veins high on the posterior bladder wall. Judicious 'spot-welding' of these veins at the bladder neck, alongside the verumontanum and in the bulbar urethra was performed using diathermy coagulation. At 6-month review,t he patient was free of postcoital haematospermia and haematuria for the first time in 20 years. Case report 2A4 1-year-old man was referred with a1 0-year history of intermittent haematuria with clots. This had always been associated with sexual activity and ejaculation. There was CASE REPORTS

Long-standing hemospermia in a patient with megacava associated to a circumaortic renal vein

“…[ 2 ] The presence of varicose plexuses in the pelvic floor is a cause of varicose vein recurrence in the lower extremities, vulvar and pudendal varicosities, varicocele, hemorrhoids, and in some cases, hematuria and hemospermia. [ 3 4 ] The most frequent primary cause is left gonadal vein reflux, and the secondary causes include compressive syndromes, arteriovenous fistulas, postthrombotic syndromes of the iliocaval region, and vena cava anomalies. When pelvic varicosities are found, if medical treatments are not improving the symptoms, the option of choice is intravascular embolization and sclerosis.…”

Experience in post-traumatic venous malformation of urethra spongy body treatment

“…Венозная мальформация губчатого тела уретрыредкая патология, относящаяся к простым венозным мальформациям (по классификации Международного общества по изучению сосудистых аномалий (Internatio nal Society for the Study of Vascular Anomalies)) [1]. По данным научной литературы, эту патологию чаще обнаруживают на 2-м и 3-м десятке жизни [2][3][4][5]. В связи с редкостью заболевания его описания в научной периодике единичны, а эпидемиологические данные отсутствуют [2][3][4][5][6][7].…”

“…По данным научной литературы, эту патологию чаще обнаруживают на 2-м и 3-м десятке жизни [2][3][4][5]. В связи с редкостью заболевания его описания в научной периодике единичны, а эпидемиологические данные отсутствуют [2][3][4][5][6][7].…”

“…Данная аномалия представляет собой участок губчатого тела с патологически измененными венами. Она может сочетаться с сосудистыми мальформациями на других участках тела и в других органах, поэтому при ее выявлении рекомендуется дополнительное обследование пациентов [2][3][4][5].…”

Recurrent Postcoital Hematuria. A Case of Fibroepithelial Urethral Polyp in an Adult Female

“…On the contrary, an isolated gross postcoital hematuria is a very rare clinical phenomenon. Normally, this distressing symptom is present in males and is often associated with serious pathologies of the urinary tract (i.e., urinary or prostatic neoplasm, pudendal and obturator arterial bleeding, urethral varicosities, urethral coital trauma) [3–7]. To the best of our knowledge, no cases of postcoital macroscopic hematuria have been reported in females.…”