Pediatr Surg Int (1990) 5:218-220 Pediatric Surgery International © Springer-Verlag 1990 Urethral hemangioma in childhood: treatment by total excision and single-stage urethroplasty Eduardo Fernandes, J. Carlos Manivel, and Ricardo Gonzalez Departments of Urologic Surgery and Laboratory Medicine and Pathology, University of Minnesota Hospital and Clinic, Minneapolis, Minnesota, USA Accepted October 3, 1989 Abstract. We report a 4-year-old boy who had an asymp- tomatic hemangioma on the ventral aspect of the urethra that caused a dorsal curvature of the penis. Treatment con- sisted of total excision of the tumor, repair of the urethral defect using a vascularized island flap from the penile skin, and correction of the dorsal curvature of the penis by plication of the ventral aspects of the corpora cavemosa. The cosmetic and functional results were excellent. The peculiar clinical presentation, in which the tumor caused a dorsal curvature of the penis, and the treatment used have not previously been reported in the literature. Key words: Urethra - Hemangioma - Urethroplasty Introduction Urethral hemangiomas are rare: 33 cases have been re- ported in the literature to date, 14 of them diagnosed in children (Table 1). A frequent presenting symptom is urethral bleeding. Diverse methods have been reported for the treatment of urethral hemangioma, but tumor recur- rence is not unusual. We report the 15th case of urethral hemangioma diagnosed in a child. The peculiar clinical presentation for this child and the treatment used have not been previously reported. Case report A 4-year-oldboy was brought to our clinic for evaluation of a mass on the ventral aspect of the penis that had been present since birth. There was no urethral discharge, bleeding, or hematuria. The physical examination disclosed a soft, nontender mass 1.2 cm in diameter that produced a bulge Offprint requests to. R. Gonzalez, Department of Urologic Surgery, University of Minnesota Hospital and Clinic, 420 Delaware Street SE, Box 45 UMHC, Minneapolis, MN 55455, USA in the ventral aspect of the corpus spongiosum and caused a dorsal curvature of the penis (Fig. 1). Cystoscopy demonstrated a shallow ulceration and increased vascu- larity of the ventral aspect of the pendulous urethra overlying the mass. The mass disappeared when a tourniquet was placed at the base of the penis, suggesting the diagnosis of an angiomatous malformation. A cir- cumferential incision was made directly over the circumcision scar and the skin was detached toward the base of the penis (Fig. 2). The heman- gioma was completely removed by careful dissection of the urethra and corpus spongiosum with a tourniquet applied to the base of the penis. To excise the tumor completely, removal of a portion of the ventral wall of the urethra was necessary. A 12 x 8 mm elliptical island flap was fash- ioned from the skin on the ventral surface of the penis proximal to the circumferential incision (Fig. 3) and sutured to the urethral defect to cover it. An artificial erection induced at this time demonstrated that a slight dorsal curvature of the penis still existed. Two longitudinal incisions were made on the ventral aspects of the corpora cavernosa and then sutured transversely with 6 - 0 polydioxanone, which straightened the penis (Fig. 4). The penile skin was reapproximated and a 7 French multi- fenestrated indwelling tube was left in the urethra for 1 week. The histologic features of the lesion were characteristic of a cavernous hem- angioma. After 8 months of follow-up the cosmetic and functional results were excellent. Discussion Urethral hemangiomas are rare and usually cause urethral bleeding and hematuria (Table 1). These tumors do not appear to regress spontaneously, and many children have signs or symptoms since early infancy. In only 1 patient was the tumor reported as asymptomatic; it was discovered during cystoscopy performed as part of an evaluation for enuresis [1]. Various surgical procedures have been used to treat urethral hemangioma, including endoscopic fulguration [3], direct application of radium [12], arterial embolization [7], two-stage urethroplasty [ 1], total primary excision of a balanic lesion by meatotomy [9], and incision of the tumor and repair of the m'ethral defect with skin from the inguinal area [5]. Recurrence of symptoms and persistence of the mass are common when procedures other than complete open surgical excision of the tumor are performed.