Expert Consensus on the Diagnosis and Treatment of Urethral Hemangioma in Males

doi:10.13263/j.cnki.nja.2025.07.013

Abstract：In male populations, there is a special type of hematuria characterized by hematuria after ejaculation or erection, or hematospermia with hematuria, often accompanied by blood clots. Clinically, this special type of hematuria is referred to as sexual activity-related hematuria, post-orgasmic hematuria, or post-ejaculatory hematuria. Clinical studies have shown that this type of hematuria is often caused by rupture of a urethral hemangioma, and in rare cases, it may be due to rupture of a pre-urethral hemangioma. The age of onset spans all age groups, with a peak incidence between 30 and 59 years. Urethral hemangiomas are relatively rare, and their pathogenesis is not yet fully understood. Possible factors that may induce bleeding from urethral hemangiomas include chronic inflammatory stimulation, local friction, changes in local pressure due to obstruction of venous return in the urethra during penile erection, and the fragile structure of the urethral hemangioma tissue, which is prone to rupture and bleeding when subjected to pressure or stimulation. Occasional sexual activity-related hematuria can be treated conservatively with the 5α-reductase inhibitor finasteride, but for long-term, recurrent, and refractory bleeding, it is recommended to use minimally invasive surgical treatments such as plasma resection, electrocautery, or laser ablation, which often yield satisfactory therapeutic outcomes. Due to the lack of widespread awareness among urologists and andrologists about this condition, the Chinese Society of Andrology has organized domestic clinical experts to develop this consensus through repeated discussions, for reference in clinical practice.