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CASE REPORT
Year : 2000  |  Volume : 17  |  Issue : 1  |  Page : 50-51
 

Venous malformation of glans penis: An unusual cause of hematuria


Department of General Surgery, L.T.M.M.C & L.T.M. G. Hospital, Mumbai, India

Correspondence Address:
Dharmesh J Balsarkar
C-501 Bafna Apartments, Moghul Lane, Mahim, Mumbai - 400 016
India
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Keywords: Venous Malformation; Glans Penis; Hematuria


How to cite this article:
Balsarkar DJ, Gore M A. Venous malformation of glans penis: An unusual cause of hematuria. Indian J Urol 2000;17:50-1

How to cite this URL:
Balsarkar DJ, Gore M A. Venous malformation of glans penis: An unusual cause of hematuria. Indian J Urol [serial online] 2000 [cited 2014 Oct 21];17:50-1. Available from: http://www.indianjurol.com/text.asp?2000/17/1/50/41016



   Case Report Top


A 17-year-old male patient presented with painless hematuria since 5 days. A similar episode occurred 8 months ago, for which he received treatment at his native place. On admission, patient was pale (HB 8.5 gms/dl) and vital parameters were normal. Abdominal examina­tion and ultrasonography were normal. Urinary catheteri­sation was performed and there was no trace of hematuria in the urine bag but fresh pericatheter bleeding was noted. On close examination of penis, vascular lesions were ob­served on the glans extending till the external urethral meatus [Figure 1]. On cystoscopic examination, there was no extension of the vascular lesion into the urethra. Blad­der and ureteric orifices were normal. A diagnosis of bleed­ing from venous malformation of glans penis was made. After review of literature a decision to inject N-butyl cy­anoacrylate into venous malformation was taken.


   Procedure Top


A 0.5 ml solution of N-butyl cyanoacrylate was mixed with 0.6 ml lipiodol. The above solution was injected with 21 gauge needle into the venous malformation after aspi­ration of blood to confirm needle position into the lesion. Injection was given at two separate sites, one near the ex­ternal meatus and other over the glans [Figure 2]. Immediate hardening of lesion was noted. No procedure related com­plications were encountered. Post-procedure recovery was uneventful. Follow-up after two years, patient had no fur­ther episodes of bleeding per urethra.


   Comments Top


Venous malformation over glans is detected by clinical examination. [1] Cystoscopic examination is performed to rule out associated urethral and bladder venous malfor­mation. [1] Histopathology shows vascular spaces lined by endothelial cells with thin and fragile vessel wall. [1] The treatment of choice is excision with adequate margins and reconstruction procedure for large venous malformation. [1],[2]

Laser electrofulguration using Argon, KTP 532 and Nd: YAG have been used to control acute episodes of hematuria in smaller lesions with little post-procedure scarring. [1] Sclerosing agent polidocanl injection have been used with good results. [1] N-butyl cyanoacrylate has been used effec­tively in management of bleeding gastric varices. [3] We sug­gest N-butyl cyanoacrylate injection as an effective modality of treatment of venous malformation on glans as it effectively controls bleeding and prevents a surgical ex­cision and reconstruction procedure without any cosmetic deformity.

 
   References Top

1.Gerald HJ, Steven MS, Charles JD. Surgery of the penis and ure­thra. In: Patrick CW, Alan BRE, Darracott Vaughan Jr, Alan JW (eds.). Campbell's Urology (7 th edn.). Phila deephia: Saunders 1997; 3: 3327.  Back to cited text no. 1    
2.Pul-M, Pul-N. Cavernous haemangioma of the penis in an infant. Int Urol Nephrol 1995: 27: 113-115.  Back to cited text no. 2    
3.Soehendra N. Grimm H. Nam VC et al. N-Butyl-2-Cyanoacrylate: a supplement to endoscopic sclerotherapy. Endoscopy 1986; 18: 25-26.  Back to cited text no. 3    


    Figures

  [Figure 1], [Figure 2]



 

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