Urethral Bleeding

Abstract

Urethral bleeding is a relatively common reported event. Different etiologies characterize this symptom in males and females. In the male patient, urethral bleeding may suggest a urethral injury requiring urgent hospital referral. Other common causes of male urethral bleeding are linked to sexually transmitted diseases such as urethritis and condylomata of the urethral meatus. In a significant proportion of patients, the etiology of urethral bleeding will remain unknown, yet a urological referral is advisable to rule out the rare possibility of urethral neoplasms. In the female patient, it is usually more difficult to ascertain the urethral origin of bleeding because of possible confusion with an underlying gynecological ­(vulvovaginal or uterine) disease. Urethral examination usually helps to rule out benign conditions such as caruncles and diverticula as well as the rare occurrence of urethral neoplasms. In both sexes, the presence of urinary incontinence makes the differential diagnosis with hematuria difficult; hence, patients should be investigated accordingly. Unusual sexual practices that involve transurethral insertion of traumatic foreign bodies should always be kept in mind when considering urethral bleeding. A practical algorithm is provided to help the general practitioner in making decisions about female and male urethral bleeding.