目的:总结用活检钳治疗男性性交相关性血尿的临床经验,电凝和钬激光烧灼。
方法:从2018年7月至2022年4月,我们使用活检钳治疗了11例男性性交相关血尿患者,电凝和钬激光烧灼。患者的年龄从29岁到47岁不等,伴有肉眼血尿的临床表现,在性交或勃起后,从尿道口滴血或尿液中的血凝块,3患有血精症,但没有痛苦。所有患者术前均接受泌尿外科影像学检查,以排除上尿路和膀胱病变。在操作过程中,在所有病例中,在膀胱尿道镜下在后尿道周围发现静脉曲张,5后静脉曲张有活动性出血。3例血精症患者首先进行了经前列腺精囊精囊镜检查。根据静脉曲张的范围和数量,5例患者采用电切镜电凝治疗,2采取钬激光烧灼法,其他4用活检钳破坏血管组织。手术后,导尿管保留3-7天,禁欲持续了30天,随访6个月。
结果:所有病例均顺利完成手术,10例预后良好,无复发。在电切镜下电凝治疗的患者中,有1例患者术后偶尔出现血尿和尿液中的血凝块,术后3个月出现排尿困难,他们接受了反复的电凝术,此后没有更多的复发。术后均有不同程度的尿道刺激和肉眼血尿,在1-4周内自发消失,没有像ED这样的并发症,射精疼痛,射精困难和射精无力。
结论:在没有其他泌尿生殖系统疾病的情况下,无痛性血尿,男性性交后尿液中的血凝块或甚至排尿困难可被认为是后尿道眩晕周围可能的静脉曲张的结果,可以通过用活检钳破坏血管组织来令人满意地治疗,根据位置用电切镜电凝或钬激光烧灼,静脉曲张的数量和程度。
OBJECTIVE: To summarize the clinical experience in the treatment of sexual intercourse-related hematuria in males using biopsy forceps, electrocoagulation and holmium laser cauterization.
METHODS: From July 2018 to April 2022, we treated 11 male patients with intercourse-related hematuria using biopsy forceps, electrocoagulation and holmium laser cauterization. The patients ranged in age from 29 to 47 years, with clinical manifestations of gross hematuria, blood dripping from the urethral orifice or blood clots in the urine after sexual intercourse or erection, 3 with
hemospermia, but none with pain. All the patients received urological imaging examination to exclude lesions in the upper urinary tract and bladder preoperatively. During the operation, varicose vessels were found around the posterior urethral verumontanum under the cystourethroscope in all the cases, 5 with active bleeding in the posterior varicose vessel. The 3 cases with
hemospermia first underwent trans-prostatic utricle seminal vesiculoscopy. According to the range and number of varicose vessels, 5 of the patients were treated by electrocoagulation with the resectoscope, 2 by holmium laser cauterization and the other 4 with biopsy forceps to destroy the vascular tissue. After the operation, urinary catheters were retained for 3-7 days, abstinence lasted 30 days, and the patients were followed up for 6 months.
RESULTS: The operations were successfully completed in all the cases, 10 with good prognosis and none with recurrence. Occasional postoperative hematuria and blood clots in the urine were observed in 1 of the patients treated by electrocoagulation under the resectoscope, with dysuria at 3 months after operation, who underwent repeated electrocoagulation and experienced no more recurrence thereafter. Different degrees of postoperative urethral irritation and gross hematuria were found in all the cases, which spontaneously disappeared within 1-4 weeks, with no such complications as ED, ejaculation pain, ejaculation difficulty and ejaculation weakness.
CONCLUSIONS: In the absence of other genitourinary diseases, painless hematuria, blood clots in the urine or even dysuria in males after sexual intercourse can be considered as the results of possible varicose veins around the posterior urethral verumontanum, which can be treated satisfactorily by destroying the vascular tissue with biopsy forceps, electrocoagulation with the resectoscope or holmium laser cauterization according to the location, number and degree of varicose veins.