性生活相关性血尿12例的治疗经验总结及文献回顾  

Diagnosis and treatment of 12 cases of sexual activity-related hematuria:Experience and literature review

作　　者：王磊 曹欢 朴曙光 宋奇翔 许成 刘春生 刘智勇 WANG Lei;CAO Huan;PIAO Shu-guang;SONG Qi-xiang;XU Cheng;LIU Chun-sheng;LIU Zhi-yong(Department of Urology,Changhai Hospital,Naval Medical University,Shanghai 200433,China;Department of Urology,Haining People's Hospital,Haining,Zhejiang 314400,China;Department of Urology,Longyan Second Hospital,Longyan,Fujian 364000,China)

机构地区：[1]海军军医大学长海医院泌尿外科,上海200433 [2]浙江省海宁市人民医院泌尿外科,浙江海宁314400 [3]福建省龙岩市第二医院泌尿外科,福建龙岩364000

出　　处：《中华男科学杂志》2020年第9期815-819,共5页National Journal of Andrology

摘　　要：目的:总结分析性生活相关性血尿的诊断及治疗经验。方法:回顾分析2015年10月至2019年4月我院收治的12例男性患者,年龄31~59岁,病程2个月至25年,其中6例表现为阴茎勃起时即出现尿道滴血;6例表现为射精后即刻血尿,其中2例同时合并血精症状。所有患者行尿道镜检查并利用电切环电灼或钬激光烧灼病损尿道粘膜,其中1例同时行精道内镜术探查精道冲洗精囊,1例同时行精道内镜术和经尿道前列腺电切术(TURP)。结果:12例均可诊断为后尿道静脉曲张,其中1例合并球部尿道及后尿道静脉曲张,1例合并存在精囊炎,1例合并存在前列腺增生。12例术后随访时间3个月至45个月不等,平均随访23.5个月,11例性生活相关性血尿症状均消失,未见复发,排尿通畅,1例于术后2个月及10个月出现射精后血尿各1次,后未再发生。所有患者均无附睾炎,尿道狭窄,勃起功能障碍等并发症。结论:阴茎勃起或性生活后出现一过性无痛性肉眼血尿首先要考虑尿道静脉曲张,但也需考虑其他疾病,如精囊出血等。尿道镜联合精道内镜对勃起或性生活后血尿诊断及治疗有效。Objective:To summarize and analyze the experience in the diagnosis and treatment of sexual activity-related hematuria.Methods:A retrospective analysis was conducted on 12 cases of sexual activity-related hematuria treated in Changhai Hospital from October 2015 to April 2019.The patients ranged in age between 31 and 59 years,with a disease course of 2 weeks to 25 years,6 complaining of urethral bleeding at penile erection and another 6 hematuria immediately after ejaculation,including 2 accompanied by hemospermia.All the patients underwent urethroscopy and cauterization of the lesioned urethral mucosa with the electric excision ring or holmium laser.In addition,one of the patients received seminal tract endoscopic exploration and seminal vesicle irrigation,and another one seminal tract endoscopy and transurethral resection of the prostate.Results:All the patients were diagnosed with posterior urethral varicosity,one accompanied with bulbar and posterior urethral varicosity,one with seminal vesiculitis,and still another with BPH.The patients were followed up for 3-45(mean 23.5)months,during which the symptoms of sexual activity-related hematuria disappeared in 11 cases,with smooth urination and no recurrence,and post-ejaculation hematuria developed in one case at 2 and 10 months postoperatively but never again thereafter.No complications,such as epididymitis,urethral stricture and ED,were observed in any of the patients.Conclusion:Urethral varicosity should be first considered in patients with painless hematuria immediately after penile erection or sexual activity though other conditions such as seminal vesicle bleeding can also be taken into account.Urethroscopy combined with seminal tract endoscopy is effective in the diagnosis and treatment of sexual activity-related hematuria.

关 键 词：性生活相关血尿 尿道镜 精道内镜 尿道静脉曲张 

分 类 号：R699[医药卫生—泌尿科学]