[1]黄灶明,李彦锋,张勇,等.34例尿道血管瘤临床特征及内镜诊治效果分析[J].第三军医大学学报,2019,41(20):1995-1999.
 HUANG Zaoming,LI Yanfeng,ZHANG Yong,et al.Clinical characteristics and endoscopic treatment of urethral hemangioma: analysis of 34 cases[J].J Third Mil Med Univ,2019,41(20):1995-1999.
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34例尿道血管瘤临床特征及内镜诊治效果分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第20期
页码:
1995-1999
栏目:
临床医学
出版日期:
2019-10-30

文章信息/Info

Title:
Clinical characteristics and endoscopic treatment of urethral hemangioma: analysis of 34 cases
作者:
黄灶明李彦锋张勇罗勇聂志林周波冯庆兴李珂江军
陆军军医大学(第三军医大学)大坪医院泌尿外科
Author(s):
HUANG Zaoming LI Yanfeng ZHANG Yong LUO Yong NIE Zhilin ZHOU Bo FENG Qingxing LI Ke JIANG Jun

Department of Urology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
尿道血管瘤射精后血尿血精尿道膀胱镜
Keywords:
posterior urethral hemangioma post-ejaculation hematuria hemospermia urethrocystoscopy
分类号:
R699.6;R737.1
文献标志码:
A
摘要:

目的 总结和探讨尿道血管瘤患者的临床特征、诊断和内镜治疗经验。方法 收集本院2014年5月至2018年12月收治的34例尿道血管瘤患者的临床资料,回顾性分析其诊断过程和内镜手术情况,随访观察其疗效及并发症。结果 34例男性患者,年龄18~61(44.7±10.3)岁。病史1个月~20年,中位时间24个月。主要症状表现为血精伴射精后首次尿液为血尿、尿中可伴血凝块。患者均经尿道膀胱镜检查确认,显示后尿道血管瘤或异常曲张血管33例,前尿道血管瘤1例;主要典型表现为精阜远端0.5~1.0 cm出现(0.5~0.8)cm×1.0 cm暗红色血管瘤样团块病变,触之易出血。18例行经尿道血管瘤电切术,术后病理为海绵状血管瘤15例,蔓状血管瘤1例,未分类血管瘤2例。16例行电灼术,未取得病理标本。术后随访1~56个月,中位时间17个月,32例患者症状消失,2例患者在术后2、3个月时血精伴血尿复发,再次电灼后症状消失。1例在术后早期发生急性附睾炎外,其余患者未出现相关并发症。结论 后尿道血管瘤主要表现为反复或持续性血精伴射精后首次尿液带血。膀胱尿道镜检查联合精囊按摩可鉴别是否存在精道出血并明确诊断。经尿道电切术或电灼术是治疗后尿道血管瘤的一种安全、有效的微创方法。

Abstract:

Objective To summarize the clinical characteristics, diagnosis and endoscopic treatment of urethral hemangioma. MethodsWe retrospectively collected the clinical data of 34 patients with urethral hemangioma admitted in our hospital between May, 2014 and December, 2018. The etiological diagnosis and endoscopic surgery data were analyzed in these cases, and the patients were followed up to assess the treatment efficacy and complications. ResultsThe 34 patients had a mean age of 44.7±10.3 years (range 18-61 years) with a disease course ranging from 1 month to 20 years (median 24 months). The main symptom was hematospermia with postcoital hematuria and occasional blood clots in the urine. All the patients underwent urethrocystoscopy, which revealed posterior urethral hemangioma (PUH) or abnormal varicose vessels in 33 cases, and anterior urethral hemangioma in 1 case. The typical findings in urethrocystoscopy included hemorrhagic lesions of dark red hemangioma-like mass measuring (0.5-0.8 cm)×1.0 cm, located 0.5-1.0 cm distal to the verumontanum. Among these patients, 18 underwent transurethral resection of the urethral hemangioma, and pathological examination reported cavernous hemangioma in 15 cases, vascular hemangioma in 1 case, and unclassified hemangioma in 2 cases; the other 16 patients underwent electrocautery and no pathological specimens were obtained. During the postoperative follow-up for 1-56 months (median 17 months), the symptoms disappeared in 32 patients; relapse occurred at 2 and 3 months after the operation in 2 patients, and the symptoms were resolved after further transurethral electrocauterization. Except for one patient who developed acute epididymitis early after the operation, none of the patients experienced complications related to the operation. ConclusionPosterior urethral hemangioma is mainly characterized by repeated or persistent hematospermia with post-ejaculation hematuria. Urethrocystoscopy combined with seminal vesicle massage can confirm the bleeding of the seminal duct for a definite diagnosis. Transurethral resection or electrocauterization is safe, effective and minimally invasive for treatment of posterior urethral hemangioma.

参考文献/References:

[1]SUH Y, GANDHI J, JOSHI G, et al. Etiologic classification, evaluation, and management of hematospermia[J]. Transl Androl Urol, 2017, 6(5): 959-972. DOI: 10.21037/tau.2017.06.01.
[2]CATTOLICA E V. Massive hemospermia: a new etiology and simplified treatment[J]. J Urol, 1982, 128(1): 151-152. DOI: 10.1016/s0022-5347(17)52793-7.
[3]SAITO S. Posterior urethral hemangioma: one of the unknown causes of hematuria and/or hematospermia[J]. Urology, 2008, 71(1): 168.e11-168.e14. DOI: 10.1016/j.urology.2007.09.058.
[4]HAN H, ZHOU X G, FAN D D, et al. An unusual etiology for hematospermia and treatments that were successful[J]. Urology, 2015, 86(4): 740-743. DOI: 10.1016/j.urology.2015.06.031.
[5]TIAN L, HAN H, LEI H, et al. Clinical features of haematospermia associated with seminal vesicle calculi versus posterior urethral haemangioma[J]. Andrologia, 2018, 50(8): e13072. DOI: 10.1111/and.13072.
[6]LEARY F J, AGUILO J J. Clinical significance of hematospermia[J]. Mayo Clin Proc, 1974, 49(11): 815-817.
[7]PAPP G K, KOPA Z, SZAB F, et al. Aetiology of haemospermia[J]. Andrologia, 2003, 35(5): 317-320.
[8]HAYASHI T, IGARASHI K, SEKINE H. Urethral hemangioma: case report[J]. J Urol, 1997, 158(2): 539-540. DOI: 10.1016/s0022-5347(01)64530-0.
[9]FURUYA S, OGURA H, TANAKA Y, et al. Hemangioma of the prostatic urethra: hematospermia and massive postejaculation hematuria with clot retention[J]. Int J Urol, 1997, 4(5): 524-526. DOI: 10.1111/j.1442-2042.1997.tb00299.x.
[10]Noviello C, Romano M,Cobellis G, et al. Posterior Urethral Hemangioma in Children: a Possible Cause of Haematuria[J]. Med. Surg. Ped. 2011, 33: 135-137.
[11]马建军, 保庭毅, 姜雪. 腔内钬激光治疗尿道血管瘤[J]. 实用儿科临床杂志, 2005, 20(7): 704-705.
MA J J, BAO T Y, JIANG X. Endourological treatment of pediatric urethral hemangioma with holmium laser[J]. J Appl Clin Pediatr, 2005, 20(7): 704-705.
[12]田龙, 韩虎, 张小东. 后尿道血管瘤的临床特点及长期随访结果[J]. 医学与哲学(B), 2018, 39(3): 51-53.
TIAN L, HAN H, ZHANG X D. Clinical features of posterior urethralhemangioma and its long-term follow-up outcomes postoperation[J]. Med Philos B, 2018, 39(3): 51-53.
[13]梁思敏, 苟欣. 男性尿道血管瘤的诊治: 附3例报告[J]. 罕少疾病杂志, 2006, 13(4): 43-44.
LIANG S M, GOU X.Diagnosis and treatment of male urethral hemangioma: report of 3 cases[J]. J Rare Uncommon Dis, 2006, 13(4): 43-44.
[14]吴实坚, 杨槐, 胡卫列, 等. 后尿道血管瘤的诊断和治疗体会(附6例报告)[J]. 中国男科学杂志, 2012, 26(6): 28-30.
WU S J, YANG H, HU W L, et al. Analysis of diagnosis and treatment of posterior urethralhemangioma (report of 6 cases)[J]. Chin J Androl, 2012, 26(6): 28-30.
[15]DE LEN J P, ARCE J, GAUSA L, et al. Hemangioma of the prostatic urethra: holmium laser treatment[J]. Urol Int, 2008, 80(1): 108-110. DOI: 10.1159/000111741.
[16]EFTHIMIOU I, KAVOURAS D, VASILAKIS P, et al. Hemangioma of penile urethra-treatment with simple transurethral excision: a case report[J]. Cases J, 2009, 2(1): 6199. DOI:10.4076/1757-1626-2-6199.
 

更新日期/Last Update: 2019-10-25