Bullous lesion in the prostatic urethra: morphological change caused by putative chlamydial infection

The cause of benign bullous lesions in the prostatic urethra, which we encountered in 10 patients during the last 18 years and which has not been described in literature, was studied.

Among 1,236 patients who underwent cystourethroscopy for a urological complaint 10 had bullous lesions in the prostatic urethra which were empirically thought to be inflammatory rather than tumorous lesions at initial cystourethroscopy. We retrospectively searched for common clinical characteristics for these 10 patients who had a median age of 33.5 years (range 20 to 47). The reasons for cystourethroscopy were terminal gross hematuria in 3 patients, initial gross hematuria in 1, total gross hematuria in 2, blood stain on underpants without scrotal keratoangioma in 1, hemospermia in 1 and voiding difficulty in 2.

Based on the results of urinalysis, expressed prostatic secretion, transrectal examination of the prostate, cystourethroscopy, urethral swab test for Chlamydia trachomatis and punch biopsy of urethral mucosa with or without immunofluorescence staining with fluorescein isothiocyanate labeled monoclonal antibody for C. trachomatis, inflammation of the prostatic urethra was considered the cause of these bullous lesions.

Bullous lesions in the prostatic urethra appear to be due to an inflammatory change. We should consider these lesions when we encounter young patients with asymptomatic gross hematuria. We should also note microscopic pyuria in such patients and subsequently perform C. trachomatis polymerase chain reaction test using urine initially as a noninvasive examination before cystourethroscopy.