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Objective:To explore the pathogenesis and treatment of severe hematuria after sexual activity in men.Methods:A retrospective analysis of 10 patients with severe hematuria after sexual activity who were admitted from January 2017 to January 2020, including 4 cases from Peking University People’s Hospital, 3 cases from Donghua Hospital Affiliated to Sun Yat-sen University, 2 cases from Second Hospital of Tianjin Medical University, and 1 case from Tianjin Jinnan Hospital. The average age of the patients was (33.5±7.6) years old. All 10 cases had severe hematuria and blood clots within 1 hour after sexual activity. The blood routine examination revealed that there were different degrees of hemorrhagic anemia after 24 hours of admission, and the average hemoglobin was(95.8±8.9)g/L. Ten patients underwent transurethral cystoscopy electrosurgical resection and / or electrocoagulation under subarachnoid anesthesia or epidural anesthesia. All patients were confirmed to be bleeding from posterior urethral lesions, including 4 cases located in the distal seminal caruncle, 5 cases in the prostate, and 1 case in proximal seminal caruncle. Three cases whose bleeding from varicose veins in the prostate urethra were treated with electrocoagulation in order to stop the bleeding, and lesions were removed in the other 7 cases for pathological examination. The F16 urinary catheter was indwelt after the operation.Results:All 10 operations in this group were successfully completed. Six cases of posterior urethral hemangioma rupture and 1 case of posterior urethral polyp were confirmed by the pathological examination in 7 cases. The urinary catheter was successfully removed 1 week after operation. Abstinence was required for 1 month after operation. There was no recurrence of hematuria after resuming sexual activity, and no complications such as dysuria or urinary incontinence.Conclusion:Severe hematuria after sexual activity is mostly caused by rupture or bleeding of abnormal blood vessels in the posterior urethra. Transurethral resection and/or electrocoagulation are the first choice for treatment. The effect is reliable and the prognosis is satisfactory.
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Objective Compare the efficacy of superselective arterial embolization with observation in the treatment of HFP caused by trauma.Methods From Jan,2013 to Dec,2017,6 traumatic HFP patients were involved into the study,the age range from 18 to 44 years old,with an average age of 26.2 years.The fistula was measured by doppler ultrasonography before the treatment with its longest diameter,and which ranges from 0.8 to 1.4 cm,the average diameter is 1.14 cm.All patients are divided into two groups according to their treatment.Operation group:4 patients underwent the pudendal artery superselective gelatin sponge vascular embolization.Control group:2 cases were treated with local cold compressing under watchful waiting.In control group,patients are treated by local cold compress with ice bag for 3 weeks:15 mins × 10 times every day.The erectile hardness of the patients was observed and the fistula was evaluated by doppler ultrasonography 3 weeks later,and all the patients were reexamined by doppler ultrasonography 1 year later.The erectile hardness was divided into four grades according to the patient~ subjective feelings:grade Ⅰ,the penis was enlarged but not rigid;grade Ⅱ,the penis had hardness,but not enough to insert into the vagina;grade Ⅲ,the penis could be inserted into the vagina,but not to achieve complete erection;grade Ⅳ,the penis fully erect and firm.The erectile function was evaluated with the International Index of Erectile Function-5(IIEF-5) after 1-year's follow-up.Results 4 patients in the operation group were operated successfully without obvious complications after operation.Median follow-up time of all the patients was 21 months (5-50).In group operation,4 cases of surgical patients did not have the recurrence of priapism.There was no obvious abnormality in the color doppler ultrasound of penis.The score of IIEF-5 was 25,24,24 and 23,respectively.Postoperative erectile function made a complete recovery.In group observation,2 patients under watchful waiting still have grade Ⅱ-Ⅲ sustained priapism,IIEF-5 score is 21 and 19 respectively,the penis color doppler ultrasound scan still showed the change of arteriovenous fistula.Conclusion Superselective arterial embolization is effective in the treatment of HFP,and the recovery of sexual function is better after operation compared with watchful waiting.
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Objective To study the diagnosis and treatment of retroperitoneal schwannoma.Methods Clinical data of 11 cases of primary retroperitoneal schwannomas were analyzed retrospectively from February 1990 to September 2014.There were 6 males and 5 females,with a median age of 46 years,and the median tumor size was 9.6 cm (4.5-12.3 cm).Seven cases were revealled due to physical examination,3 cases were revealled due to ipsilateral lower back pain or discomfort,and 1 case was revealled due to right lower extremity numbness.There were no clinical manifestations of hypertension or appearance shape change,and there were no abnormal findings in routine laboratory and endocrine examinations.Radiological examination showed a retroperitoneal mass.There were 3 cases in the left adrenal gland,1 case in the right adrenal gland,3 cases in the lower pole of left kidney and 4 cases in the lower pole of right kidney.Four patients were initially diagnosed as adrenal tumors,and 7 patients were diagnosed as kidney tumors.Results All the 11 cases underwent surgical resection,with 7 cases of complete resection,1 case of capsule resection,2 cases of partial resection and 1 case of biopsy.The pathology of immunohistochemical staining showed S-100 positive in 10 cases of benign retroperitoneal schwannomas.During the follow-up period for 1.5-24 years (median 14 years),no recurrence and malignance was observed.One case of malignant retroperitoneal schwannoma died of multiple metastases in 17 months after opreation.Conclusions Primary retroperitoneal schwannoma is rare and preoperative diagnosis is difficult.Clinical manifestations and radiological findings are usually nondiagnostic,and histopathology is the only way for final diagnosis.Complete surgical resection is proved to be the best choice.
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Objective To investigate the clinical features,diagnosis,treatment and prognosis of bladder hemangio-ma. Methods The clinical data of 12 patients with bladder hemangioma were retrospectively reviewed and analyzed in com-bination with relevant literature. Results Ten patients were treated with partial cystectomy,and two patients treated with transurethral resection of bladder tumor (TUR-BT). All patients were diagnosed as the bladder hemangioma by postoperative pathology. Patients were followed up from 4 months to 6 years. There were no recurrence and metastasis in all cases. Conclu-sion Bladder hemangioma is a rare benign tumor, which can be preliminarily diagnosed by combinating with medical imag-ing. The final diagnosis depends on the pathological examination. Treatment options should rely on the factual situations. The partial cystectomy is the first choice for the treatment of bladder hemangioma. The prognosis is good.