ĐẶC ĐIỂM LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ GIÃN TĨNH MẠCH NIỆU ĐẠO BẰNG LASER HOLMIUM

Abstract

Objective: Recurrent post-ejaculation hematuria is a rare clinical symptom, commonly associated with the spectrum of hematospermia, causing difficulties in diagnosis and treatment. This study was conducted to determine the etiology and evaluate the treatment outcomes.

Subjects and methods: A descriptive case series study was conducted on 20 patients presenting with recurrent erection-related hematuria between January 2022 and May 2023. The etiologic diagnostic process and surgical outcomes were assessed through history-taking, evaluation of therapeutic efficacy, and monitoring of complications during treatment as well as follow-up.

Results: The mean age of the study population was 50 years, and the mean disease duration was 64 months. Among the 20 study subjects, 10 cases were admitted because of fresh blood or blood clots during the first voiding after ejaculation, 2 cases presented with penile bleeding during sexual intercourse, and 8 cases experienced urethral bleeding when the penis had just become erect but before sexual intercourse. All patients underwent diagnostic urethrocystoscopy, and abnormal dilated vessels in the posterior urethra were detected in 100% of cases. All patients were treated with transurethral endoscopic ablation of the dilated veins using a holmium laser. The mean postoperative follow-up period was 9.5 months; all patients who had sexual intercourse after surgery no longer experienced hematospermia. Five out of 20 patients returned for follow-up 3 months after surgery, underwent follow-up urethroscopy, and were found to have complete disappearance of urethral varices.

Conclusion: Recurrent erection-related hematuria may be associated with abnormal urethral varices in the posterior urethra. Transurethral endoscopic ablation of dilated urethral veins using a holmium laser is a safe, effective, and valuable treatment method for symptom control in this group of patients.