Experience in post-traumatic venous malformation of urethra spongy body treatment

Abstract

The study objective is to present a clinical observation of a 17-year-old boy with post-traumatic venous malformation of the spongy urethra. Clinical case. The patient was hospitalized in an urgent order with complaints of urethrorrhagia. Medical history showed that the first episode of urethrorrhagia happened at 3 years of age and could be caused by a self-injury of the urethra due to mentally traumatic events in the family. After catheterization of the bladder, urethral bleeding stopped, but in the early morning blood seeped past the catheter. Urethroscopy showed an area of modified urethra distally from the penoscrotal junction in the form of pockets with partitions of scar tissue 3 × 1 cm in size that we considered a post-traumatic abnormality. Ultrasound of the corpus spongiosum and magnetic resonance imaging of the genitals didn’t provide additional information. Repeat urethroscopy performed during erection allowed to visualize pathologically dilated vessels bulging into the urethral lumen which were the source of bleeding. Spongiosography allowed to visualize a pathological vascular tree. Diagnosis of post-traumatic venous malformation of the spongy urethra was made. The pathological area was resected with preservation of the fibrous tunic of the corpus spongiosum. The defect was substituted by a flap of the inner preputial leaf. Follow-up observation lasted for 1 year with no urethrorrhagia episodes, the patient didn’t experience any discomfort during sex or micturition.Conclusion. Due to the rarity of this pathology and complexity of diagnosis, the whole spectrum of diagnostic methods should be applied, with urethrocystoscopy and spongiosography being the most informative. Selection of treatment method depends on many factors. If the malformation is located near the urethra, electrocoagulation and angioembolization are ineffective. Resection of the venous malformation within normal tissue and substitution urethroplasty with preputial flap allowed to achieve good clinical and functional result.