|Year : 2000 | Volume
| Issue : 1 | Page : 50-51
Venous malformation of glans penis: An unusual cause of hematuria
Dharmesh J Balsarkar, MA Gore
Department of General Surgery, L.T.M.M.C & L.T.M. G. Hospital, Mumbai, India
Dharmesh J Balsarkar
C-501 Bafna Apartments, Moghul Lane, Mahim, Mumbai - 400 016
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
| Case Report|| |
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|| |
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|| |
Venous malformation over glans is detected by clinical examination.  Cystoscopic examination is performed to rule out associated urethral and bladder venous malformation.  Histopathology shows vascular spaces lined by endothelial cells with thin and fragile vessel wall.  The treatment of choice is excision with adequate margins and reconstruction procedure for large venous malformation. ,
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.  Sclerosing agent polidocanl injection have been used with good results.  N-butyl cyanoacrylate has been used effectively in management of bleeding gastric varices.  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|| |
|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. |
|2.||Pul-M, Pul-N. Cavernous haemangioma of the penis in an infant. Int Urol Nephrol 1995: 27: 113-115. |
|3.||Soehendra N. Grimm H. Nam VC et al. N-Butyl-2-Cyanoacrylate: a supplement to endoscopic sclerotherapy. Endoscopy 1986; 18: 25-26. |
[Figure 1], [Figure 2]