The association of urethrorrhagia and urethral stricture disease

Urethrorrhagia characterized by terminal hematuria and/or bloody spotting of the underwear between episodes of voiding is a common problem of childhood. We describe a series of boys with urethrorrhagia and associated clinical and endoscopic findings.

The records of boys presenting between 1990 and 2005 with urethrorrhagia were retrospectively reviewed for age, symptoms, symptom duration, physical examination, radiographic evaluation, laboratory data and endoscopic findings.

Of 66 boys, 50 presented with classic symptoms of terminal hematuria and/or blood spotting, and 16 with atypical symptoms who underwent cystoscopy with similar findings. Endoscopic evaluation was performed in 55 (82%) patients for prolonged symptomatology or recurrent symptoms and revealed four distinct patterns: Group 1, three (5%) patients with a normal appearing urethra; Group 2, 27 (49%) patients who were found to have inflammation or hyperemia of the bulbar urethra; Group 3, 17 (31%) cases in which there was a white membranous exudate or mucosal irregularity; and Group 4, eight (14%) patients who were found to have stricture disease on cystoscopy. Stricture developed after initial cystoscopy in six cases.

Consistent with previous studies, a subset of patients developed urethral stricture disease after presenting with urethrorrhagia. As eight patients had a urethral stricture on initial cystoscopy, and those with strictures are clinically indistinguishable symptomatically from those without, we feel that uroflow and selective cystoscopy are important tools for the work-up of severe and persistent cases of urethrorrhagia. Group 3 may represent a population at significant risk for the development of stricture disease warranting closer follow up and evaluation. The white membranous exudate found on cystoscopy may represent a pre-stricture lesion as evidenced by four cases that subsequently developed strictures.