Urethrorrhagia

Abstract

The term urethrorrhagia is used to describe bleeding from the urethra. It is largely a pediatric problem and commonly presents with blood spotting in the underwear between episodes of voiding or terminal hematuria. By definition, urethrorrhagia is “gross hematuria,” but the distinctive finding of passing blood from the urethral meatus without voiding indicates that the source of bleeding is within the urethra at some point distal to the bladder neck. Any gross bleeding from a source above this will result in total hematuria, with the entire voided specimen being discolored (red or brown). Urethrorrhagia may also present during voiding with initial bloody appearance of the urine, but clear urine during the midstream. (Only 60 % of patients with observed urethrorrhagia will dipstick positive for blood on standard midstream urinalysis.) The other important complaint that will be associated in some cases is that of dysuria. Once the distinctive presentation is recognized, the differential diagnosis and resultant evaluation of urethrorrhagia prove to be quite different from the standard evaluation of gross hematuria in a child. It is important for both pediatricians and urologists to recognize this difference and, thereby, avoid imaging and lab evaluation that are unlikely to be helpful.