Urethral Hemangioma: A Case ReportWu Guang¹, Le Xiang¹, Xiao Chuan², Zhu Yuhong³¹Department of Urology,Suzhou Municipal Hospital,Affiliated Hospital of Nanjing Medical University (Suzhou,Jiangsu,215006)²Department of Pathology,Suzhou Municipal Hospital,Affiliated Hospital of Nanjing Medical University (Suzhou,Jiangsu,215006)³Department of Urology,The First Affiliated Hospital of Soochow University (Suzhou,Jiangsu, 215006)【Abstract】Objective:To investigate the clinical character of urethral hemangioma.Methods:The clinical data of one case of this disease was reported.The patient presented with recurrent urethral bleeding after sexual activity.Imaging examinations including B-ultrasound and CT showed no specific findings.Urethrocystoscopy revealed a purplish-red,mulberry-like raised lesion,approximately 1cm*0.8cm in size,located distal to the verumontanum near the external sphincter.The lesion had a smooth surface, relatively clear boundaries,and visible dilated blood vessels. It bled easily upon contact.Transurethral electroresection of the hemangioma was performed.Histology was consistent with hemangioma.Results:The patient was followed up for 12 months,with no recurrence observed.Conclusions:Urethral hemangioma is a congenital benign vascular malformation with a favorable prognosis.Its clinical manifestations are diverse and lack specificity. Urethrocystoscopy is the ”gold standard” for diagnosing urethral hemangioma,while pathological examination is the basis for definitive diagnosis.Surgical treatment is the most effective therapy.[Keyword]Urethral hemangioma;Clinical manifestations;Diagnosis;Treatment【Key Clinical Message】This case report on urethral hemangioma provides a detailed elaboration on its etiology, clinical manifestations, diagnosis, and treatment, aiming to enhance clinicians’ understanding of this condition, reduce the rates of missed diagnosis and misdiagnosis.Urethral hemangioma is an extremely rare benign vascular malformation of the urinary system[1].Its clinical manifestations lack specificity[2],making it prone to missed diagnosis or misdiagnosis[3].This article reports the clinical data of one case of urethral hemangioma and reviews relevant literature to further understand the clinical features of this disease.1. Case ReportA 61-year-old male patient was admitted due to ”recurrent postcoital urethral bleeding for over five years,aggravated for one week.”For more than five years,the patient noticed bright red blood at the beginning of the first urination after each sexual intercourse,without clots,and no urinary frequency,urgency,dysuria,or difficulty urination.There was no low back or abdominal pain,and urine color was normal during intervals.In the past week,postcoital hematuria worsened,accompanied by a large amount of blood clots and symptom of difficulty urination.The patient had undergone multiple urinalyses and urinary system B-ultrasound examinations at other hospitals,all showing no abnormalities.Specialist physical examination: No percussion pain in the kidney areas,no deep tenderness along the ureter courses,no bulge or tenderness in the suprapubic bladder area.External genitalia were normally developed,no redness,swelling,or abnormal discharge at the urethral meatus.No definite induration was palpated in the anterior urethra.Blood routine and coagulation function were normal. Urinalysis (non-bleeding period) showed no red blood cells.Imaging studies:Urinary system B-ultrasound showed no significant space-occupying lesions in the kidneys,ureters,or bladder. Abdominal CT plain scan and enhancement indicated slight enlargement of the left seminal vesicle,but no definite abnormal signal or mass in the urethral region.Given the typical and persistent clinical symptoms with negative routine examinations,urethrocystoscopy was decided to identify the cause.Urethrocystoscopy:A purplish-red,mulberry-like protruding lesion approximately 1cm*0.8cm in size was observed near the external sphincter distal to the verumontanum.The lesion had a smooth surface,relatively clear borders,visible dilated vessels,and bled easily upon contact (Figure 1).Diagnosis under endoscopy:Posterior urethral hemangioma.Further,transurethral resection of the hemangioma was performed under combined spinal-epidural anesthesia.During surgery,the base of the hemangioma and a small amount of surrounding normal mucosa were completely resected using a resection loop(Figure 2).The procedure was smooth with minimal bleeding.A urinary catheter was retained for 5 days postoperatively.After removal,urination was smooth without gross hematuria.Postoperative pathology:Indicated hemangioma (Figure 3),CD31(+) (Figure 4),CD34 vessel wall (+), urothelium CK7,P63, CD44 (+),CK20 (-),Ki-67 scattered in a few cells (+) (Figure 5).At 3-month, 6-month, and 12-month follow-ups,the patient no longer experienced postcoital bleeding.Repeat urethroscopy showed smooth mucosal healing at the original surgical site,with no signs of residual hemangioma or recurrence.