A multicenter retrospective study of 108 men with urethral hemangioma.

BACKGROUND: Male urethral hemangioma is a rare but highly under-recognized cause of sex-related hematuria and hematospermia. Existing evidence is limited to small case series. This study aimed to characterize the clinical features and long-term outcomes of male urethral hemangioma treated with cystourethroscopy followed by immediate endoscopic treatment, and to evaluate risk factors for recurrence and patient-reported outcomes (PROs). METHODS: This retrospective multicentered cohort study included 108 men with urethral hemangioma from Affiliated Hospital of Guizhou Medical University and Army Medical Center from 2014 to 2025 with at least 3-month follow-up. Baseline characteristics, lesion location, perioperative variables, and follow-up data were collected. PRO failure was defined as any of: patient global impression of change as no change or worse, overall satisfaction ≤7 (out of 10), or fear-driven avoidance of sexual activity over the past 3 months. Conventional logistic regression was used to identify factors associated with PRO failure, and Firth penalized Cox proportional regression was applied to explore risk factors for recurrence. RESULTS: Following cystourethroscopy and immediate endoscopic surgery, symptoms resolved within 6 weeks in 100% of patients, recurrence occurred in 8 (7.4%) cases with a median of 55 months follow-up. PRO failure occurred in 17 (15.7%) cases and was independently associated with baseline lower urinary tract symptoms (LUTS) [odds ratio 3.4 (1.089, 11.114), P=0.04], but not with age (P=0.12) or recurrence (P=0.41). Multiple lesions [hazard ratio 5.732 (1.044, 31.468), P=0.04] were independently associated with recurrence in Firth regression, whereas typical versus atypical location was not (P=0.31). CONCLUSIONS: Cystourethroscopy followed by immediate endoscopic treatment is a safe and effective one-step diagnostic-therapeutic strategy with low long-term recurrence and high patient satisfaction. Baseline LUTS and lesion multiplicity offer clinically relevant risk stratification for PROs and recurrence.