Urethral Hemangioma Treated With Transurethral Coagulation Using Narrow-Band Imaging: A Case Report

A 49-year-old man consulted his previous doctor, reporting occasional episodes of macroscopic hematuria after an erection. Cystourethroscopy under artificial erection revealed findings suggestive of a hemangioma in the membranous urethra. The frequency of hematuria decreased with the use of 5α-reductase inhibitors (5ARIs) and hemostatic agents but subsequently increased, leading to the patient's referral to our department for further examination and treatment. Under general anesthesia and in the lithotomy position, an artificial erection was induced by injecting 80 mg of papaverine hydrochloride into the corpus cavernosum, and a cystourethroscopy was performed using white light. A mass was identified extending from the distal verumontanum of the prostatic urethra to the membranous urethra. Due to the proximity of the hemangioma to the urethral sphincter, narrow-band imaging (NBI) was used for precise identification, followed by biopsy and coagulation. The histopathological findings were a cavernous hemangioma. The patient experienced no recurrence of hematuria or urinary incontinence. Urethral hemangioma, a known cause of posterectile hematuria, can be effectively diagnosed and treated via endoscopic observation during induced erection. In this case, NBI facilitated the accurate visualization of the hemangioma, enabling surgical resection without postoperative complications such as urinary incontinence, despite the mass's proximity to the urethral sphincter. NBI improves the visibility of the mass and may contribute to more accurate and safer treatment of urethral hemangiomas.