男性后尿道血管瘤诊治探讨

Diagnosis and treatment of male posterior urethral hemangioma

目的探讨男性后尿道血管瘤的临床特点、诊断、治疗及随访情况。方法选取2015年1月至2018年11月南京大学医学院附属鼓楼医院男科收治的6例性兴奋阴茎勃起后、射精后、晨勃后、负重后等特定情境下出现血尿、尿道排出血凝块或尿道口流血的男性患者临床资料作为研究对象。所有患者经抗感染治疗无效。患者经膀胱镜检查发现近精阜和尿道外括约肌处有血管瘤样结构,行经尿道电切术+电凝止血术后,观察手术效果。结果手术过程顺利,所有患者均手术成功。标本送病理检查,诊断为后尿道血管瘤。患者随访(12.3±9.7)个月,上述症状均消失,无一例复发,无逆行射精、射精痛、尿道狭窄、尿失禁等并发症发生。结论男性特定情境下出现血尿、尿道排出血凝块或尿道口流血要考虑后尿道血管瘤的可能,经尿道电切术+电凝止血术是一种安全有效的治疗手段。

Objective To investigate the clinical features,diagnosis,treatment and follow-up of male posterior urethral hemangioma.Methods The clinical data of 6 male patients with hematuria or urethra excreted blood clots or urethral orifice bleeding in specific circumstances such as erection,post-ejaculation,morning wood,and weight-bearing were collected in the Department of Andrology of Drum Tower Hospital Af liated to Medical College of Nanjing University.All anti-infection treatment on patients were ineffective.Cystoscope examination of the patient revealed hemangiomatous structures near the verumontanum and the external sphincter of the urethra.Transurethral electrotomy and electrocoagulation hemostasis were performed,and the surgical effect was observed.Results The operation was successful in all patients.The specimen was sent for pathological examination and diagnosed as posterior urethral hemangioma.The patients were followed up for(12.3±9.7)months,and all the above symptoms disappeared without any recurrence,and no complications such as retrograde ejaculation,ejaculation pain,urethral stricture and urinary incontinence occurred.Conclusions The occurrence of hematuria,urethra excreted blood clots or urethral oriography bleeding in men under specific circumstances should consider the possibility of posterior urethral hemangioma.Transurethral electroresection and electrocoagulation hemostasis is a safe and effective treatment.