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Idiopathic Urethrorrhagia is Highly Associated with Circumcision Status, as well as, the Presence of Meatal Stenosis
Gregory E. Dean, MD, Steven Sterious, MD, Michael Packer, MD, Jonathan Roth, MD, Michelle Sheel, MSN, APN-C, Mark Zaontz, MD.
Temple University, Philadelphia, PA, USA.

Introduction:
Idiopathic Urethrorrhagia in which transient terminal hematuria is seen in boys remains poorly understood. Kaplan et al. described the entity in 1982 and suggested that it might be of viral etiology. We retrospectively reviewed patients with this disorder seen in our practice over an 11 year period and determined for the first time, that there is a highly significant correlation with circumcision status as well as the presence of urethral narrowing.
Materials and Methods
A retrospective analysis of charts over an 11 year period was performed. 174 males with a diagnosis of gross hematuria were seen. Detailed chart analysis was then performed to identify specifically those patients with terminal hematuria and dysuria as well as those patient given the specific diagnosis of Idiopathic Urethrorrhagia by the evaluating physician. A total of 80 boys were identified . Comparison was made with controls (varicocele patients) as well as comparison with CDC circumcision rates to provide statistical analysis.
Results
Of the 80 patients with urethrorrhagia, 20 (25%) of them required urethromeatoplasty after identification of a deviated urinary stream. Another 15 were noted within the chart to have either a small meatus or deviation of their stream. In combination 35/80 (44%) patients with urethrorrhagia had evidence of meatal narrowing. A p value of <0.01 was achieved when compared to the control varicocele /urethrorrhagia group. The association of urethrorrhagia and circumcision status was also evaluated. 76/80 (95 %) were circumcised. Compared to the state wide circumcision rate of 65% (CDC), this also yields a highly significant p value < 0.01. Of the 4 uncircumcised patients, only one had a normal foreskin. 2/4 had a tight phimosis with balanitis and ballooning with voiding. The final patient had a stenotic glanular hypospadias.
Discussion
We have demonstrated for the first time, a highly significant association between idiopathic urethrorrhagia and meatal stenosis as well as circumcision. The previous speculation that this disorder is of viral etiology may need to give way to a more mechanical mechanism. We speculate that meatal stenosis, which has been demonstrated to be strongly associated with circumcision, may subject the urethra to a transient traumatic pressure gradiant resulting in gross hematuria and dysuria.


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