1. Introduction

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The urethral localization of an hemangiomas is very rare. Responsible for urethrorrhagia and / or hemospermia, the diagnosis is easily made by endoscopy. On the other hand, the treatment remains difficult because of the localization urethral. Nous report the case of a man of 28 years treated with Laser Nd YAG.

2. Case Report

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A man of 28, with no particular history, had urethrorrhages associated with initial hematuria since the age of 20 years. A first endoscopic assessment, found a single hemangiomatous lesion located in the navicular fossa that was treated by electrocoagulation. Six months later, with a greater bleeding recurrence, a new urethrocystoscopy showed the appearance of a new hemangiomatous localization extended to the ventral side of the maxillary anterior urethra in the bulbar urethra and extending to on the meatus.

Arteriography was performed in search of a lesion that could be treated by embolization. This one did not find an arterial anomaly, but only a vascular puddle corresponding to the urethra at Two years after, a new abundant urethrorrhagia, motivated an attempt of endoscopic treatment by electrocoagulation at voluminous lesion located just under the striated sphincter. Due to the risk of secondary stenosis, coagulation was deliberately incomplete and bleeding recurrences were early. The patient then presented daily urethrorrhages of low abundance without any repercussion or hemodynamic, nor psychological and professional repercussion. 3 months later, Laser Nd YAG coagulation was performed. The procedure was performed under general anesthesia, using an SLT Side Firing fiber equipped with the 40-watt lateral firing tip, positioned next to a cystoscope (Storz °). It was delivered 1670 Joules distributed on the lesion of the bulbar urethra and on the localization at the level of the meatus. No urethral catheterization was performed at the end of the procedure and the patient resumed spontaneous and painless rination on awakening. He was allowed to go out that same evening the urethrorrhagia disappeared for a month, to reappear but with lesser amounts.

A second laser coagulation session was performed 6 months later. During the endoscopy, it was found that previously treated lesions had not recurred, but that the Hemangioma had a new, more distal location in the bulbar urethra (Figure 1). This one was treated with the same modalities by delivering 1400 Joules on the bulbar lesion mainly at 4 and 8 hours. A slight retraction of the mucosa during coagulation and no induced bleeding was observed (Figure 2 and 3). 6 months, all urethrorrhagia disappeared and the quality of the jet is perfect.

Figure 1    Figure 2    Figure 3

3. Discussion

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The location of a Urethral hemangiomas is very rare. They can be localized polypoid rather in the posterior urethra [8,4,17,20], the most often reported from, because the source of difficulties of treatment and responsible for the most important bleeding, differs by a diffuse attack of all the anterior urethra starting from the bulbous urethra to the meatus [1,18,21,22].

The clinical symptomatology is dominated by bleeding: urethrorrhagia or macroscopic hematuria and in adult hemospermia [7]. Cases in pediatrics suggest a congenital origin , but even in adults the symptoms sometimes go back to childhood [16]. In a 42-year-old man, a posttraumatic etiology was evoked in front of a posterior urethral lesion[5]. The presence of scrotal skin lesions [1,9] or on the glans is possible, even in the context of angiomatous disease (Klipper-Weber syndrome) [13].

The diagnosis is based on endoscopy. Recall that even in children a neoplastic etiology must be excluded formally, in particular a rabdomyosarcoma . Apart from the rare case of the localized lesion of the meatus whose surgical excision is easily performed [14,19,20], the therapeutic management of extensive lesions is difficult: many methods have been tried.

Complete surgical excision followed by reconstruction is cumbersome and causes complications Radiotherapy, attempted many years ago, is not very effective and dangerous The practice of endo-urethral instillations resulted in stenosis only. The possibility of embolizing angiomatous lesions after a vascular opacification can sometimes lead to healing [18], but is not always possible.

In infants, systemic corticosteroid treatment was able to reduce the lesions [3]. Endoscopic methods are more suitable. Endoscopically controlled injection sclerotherapy has been successful, but sometimes at the cost of iterative scans and stenos . Electrocoagulation is effective but with a still significant risk of secondary stenosis.

The use of the Laser Nd YAG is interesting since the photocoagulation in liquid medium acts in surface area of 1 to 2 mm of depth with a less risk of inducing a secondary stenosis [2,10,11]. In children, the size of the urethra renders any endoscopic treatment very delicate and requires appropriate equipment [12].

4. Conclusions

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The urethral localization of a hemangioma is rare and its treatment is not yet codified. In children, thanks to a thin endoscope and the use of laser, endoscopic treatment seems possible effectively, without secondary stenosis.

Consent Of Patients

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Written informed consent was obtained from the patient’s next of kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Authors’ Contributions

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O.Yddoussalah wrote the manuscript. All authors read and approved the final manuscript.

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