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|LETTER TO EDITOR
|Year : 2004 | Volume
| Issue : 4 | Page : 312-313
Post coital hematuria: presentation of an uncommon case
Rajeev Kumar, P Kesarwani, DN Shrivastava, AK Hemal
Departments of Urology, All India Institute of Medical Sciences, New Delhi, India
Departments of Urology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar R, Kesarwani P, Shrivastava D N, Hemal A K. Post coital hematuria: presentation of an uncommon case
. J Postgrad Med 2004;50:312-3
Isolated post-coital hematuria without hemospermia is a rare clinical presentation. It is usually benign and the aetiology is often not diagnosed despite extensive investigations. We recently encountered such a case where the aetiology was diagnosed after extensive, and possibly unnecessary evaluation; and the patient was being successfully managed using the holmium laser.
A 33-year-old male presented with complaints of hematuria after coitus for the past five years. Hematuria used to occur only once after the act and recurred every few weeks. It was painless and the patient did not have any history of hemospermia. He was married 10 years back and had two children. General and systemic examinations were unremarkable. Urine, biochemical and semen examination were normal with complete absence of red blood cells in the semen. Urine cytology for malignant cells, stain for acid fast bacilli and Polymerase Chain Reaction for Myobacterium tuberculosis (PCR-MTB) were also negative. Abdominal and transrectal ultrasonography, micturating cystourethrogram and retrograde urethrogram were also normal.
Cystourethroscopy performed under local anaesthesia did not reveal any abnormality. Magnetic resonance imaging of the pelvis showed abnormal vascularity in the region of the pubis with no clear vascular channels. Digital subtraction angiography with selective internal pudendal artery cannulation was then performed, before and after induction of a pharmacological erection using 30 mg of intracavernosal papaverine. Delayed phase image revealed an area of vascular blush and retention of contrast at the inferior border of the pubic bone.
The patient underwent cystourethroscopy under general anaesthesia, immediately after planned sexual intercourse. An erythematous plaque-like lesion with dilated vessels running over the surface of the urethra was seen distal to the tip of verumontanum. A cold-cup biopsy was taken and the leash of blood vessel along with the plaque was fulgurated using the holmium:YAG laser at a setting of 12 Watts through a 550 micron fibre. Histopathology revealed a urethral polyp with numerous vascular channels, possibly a vascular hamartoma. At six months of follow-up, the patient is asymptomatic.
Post-coital hematuria has usually been correlated with hemospermia. A common cause of hematuria and hemospermia in young men is benign papillary adenoma., Isolated hemospermia is a more common clinical condition and is often due to infections and inflammations though in up to 40% of these cases, the cause in indeterminate. Post-coital hematuria without hemospermia is rare. Aliabadi et al report a case of benign prostatic utricular papilloma presenting with post-coital urethral abnormal bleed and multiple episodes of hematuria but no hemospermia.
The post-coital hematuria in our case may be explained by the vascular smooth muscular response to the changes in autonomic innervation during the ejaculation supplemented by the increased blood flow and increased pressure generated in the posterior urethra due to the closure of the bladder neck.
Though most cases of post-coital hematuria are benign, the presentation is frightening and requires evaluation. Our case demonstrates the extent to which such investigations may need to go before the diagnosis can be made. However, in retrospect, we believe that cystourethroscopy after simulation of the circumstances of bleed may demonstrate the lesion, obviating extensive evaluation.
This is the first report regarding the use of holmium: YAG laser in the fulguration of such abnormal vascularity/ hamartoma of the prostate. The advantage of the laser lies in its precision, avoiding damage to external sphincter. No urethral catheter was required and the patient was discharged the same evening. The only disadvantage with the laser is the non-availability of proper tissue for histopathological examination.
| :: References|| |
|1.||Cattolica EV. Massive hemospermia: A new etiology and simplified treatment. J Urol 1982;128:151-2. |
|2.||Baroudy AC, O'Connell JP. Papillary adenoma of the prostatic urethra. J Urol 1984;132:120-2. |
|3.||Stein AJ, Prioleau PG, Catalona WJ. Adenomatous polyps of the prostatic urethra: A cause of hemotospermia. J Urol 1980;124:298-9. |
|4.||Mulhall JP, Albertsen PC. Hemospermia: Diagnosis and management. Urology 1995;46:463-7. |
|5.||Aliabadi H, Cass AS, Gleich P. Utricular papilloma. Urology 1987;29:317-8. |
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