Oral Propranolol in a Child With Infantile Hemangioma of the Urethra

Urethral Hemangioma Treated With Transurethral Coagulation Using Narrow-Band Imaging: A Case Report

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.

Clinical characteristics and endoscopic treatment of hematospermia with postcoital hematuria

BACKGROUND

Recurrent hematospermia accompanied by postejaculatory hematuria is a very rare phenomenon, has not been well understood in the clinical setting, and usually leads to misdiagnosis and mistreatment. The aim of this study was to summarize the clinical characteristics, etiologic diagnosis, and endoscopic treatment of hematospermia with postcoital hematuria.

METHODS

We collected the clinical data from 39 patients of hematospermia with postcoital hematuria, who were admitted to our hospital from May 2014 to October 2019. The etiologic diagnostic process and endoscopic surgery were analyzed retrospectively, and we observed and evaluated the efficacy and any complications during follow-up.

RESULTS

The average age of the 39 patients was 44.1 years (range, 18-61 years), and the disease history ranged from 1 month to 20 years, with a median duration of 24 months. All of the patients were observed by urethrocystoscopy, which showed 38 cases of posterior urethral hemangioma (PUH) or abnormal varicose vessels, and 1 case of anterior urethral hemangioma. Of these, 18 patients underwent transurethral resection of urethral hemangioma, and 21 patients underwent transurethral electrocauterization. Postoperative follow-up ranged from 1 to 56 months, with a median of 16 months. The symptoms disappeared in 37 patients and recurred in 2 patients two to 3 months after the operation. The two recurrent patients were treated again by transurethral electrocauterization, and their symptoms then disappeared.

CONCLUSIONS

PUH is the most common cause of hematospermia with postejaculatory hematuria. Herein, we demonstrated that transurethral resection or electrocauterization provides a safe, effective, and minimally invasive method for the treatment of PUH.

Propranolol as an effective therapy for infantile haemangioma of the urinary bladder

Infantile haemangiomas are one of the most common tumours in infancy, but typically present as cutaneous lesions; haemangiomas of the urinary bladder are incredibly rare. Although benign, these can sometimes ulcerate and bleed, causing haematuria in the case of bladder lesions. Propranolol is a well-documented medical therapy for cutaneous lesions, but surgical treatment dominates the literature on bladder haemangiomas. We present the case of a child with infantile haemangiomas of the urinary bladder, as well as internal and cutaneous lesions, treated with propranolol. At 6-week follow-up cystoscopy and MRI, there was a significant improvement in both bladder and internal lesions, respectively. Follow-up with dermatology 9 months after initiation of propranolol demonstrated excellent regression of the cutaneous lesions with a marked decrease in both size and prominence. This case demonstrates the potential role of propranolol in the treatment of bladder haemangiomas in lieu of more invasive surgical techniques.