Efficacy and safety of transurethral thulium laser cauterization in male patients with urethral hemangioma: a single-center retrospective case series.

BACKGROUND

Urethral hemangioma is a rare benign vascular lesion that poses diagnostic and therapeutic challenges due to its nonspecific symptoms, vascular nature, and risk of recurrence or complications such as stricture and incontinence with overly aggressive treatment. Thulium laser, with its continuous-wave mode, shallow penetration depth (0.5-1.0 mm), and favorable hemostatic properties, may offer advantages for endoscopic management of urethral vascular lesions. However, data on its use in this setting remain scarce. This study aimed to determine efficacy and safety of transurethral thulium laser cauterization (TTLC) in male patients with urethral hemangioma.

METHODS

This was a single-center retrospective consecutive case series. Using electronic medical records, we identified male patients aged ≥18 years diagnosed with urethral hemangioma confirmed by urethrocystoscopy who underwent TTLC between November 2018 and December 2025. Predefined outcomes included intraoperative blood loss, tumor residual, transfer to intensive care unit (ICU), symptom resolution at discharge, re-insertion of an indwelling catheter, and intraoperative, postoperative, and long-term complications. Follow-up was conducted via outpatient visits or telephone interviews.

RESULTS

Fifteen consecutive patients (mean age 67.7 years) with urethral hemangioma were enrolled according to the inclusion and exclusion criteria. Hematuria was the most common presentation (n=12, 80%). Four patients (26.7%) had prior transurethral resection of the prostate; 13 patients (86.7%) had first-episode disease and 2 (13.3%) had recurrence. Only 2 patients (13.3%) showed abnormal findings on preoperative imaging. All procedures were completed successfully with no intraoperative complications or ICU transfers. Median intraoperative blood loss was 10.0 (10.0, 10.0) mL. All patients were symptom-free at discharge, and none required catheter re-insertion. No perioperative or long-term complications were observed. During a mean follow-up of 33.6±24.0 months (median 39.0 months; range 2.0-72.0 months), no recurrences occurred.

CONCLUSIONS

TTLC appears to be a safe and feasible option in this small case series, with promising perioperative outcomes (less bleeding, greater safety, faster recovery, and fewer perioperative complications) and no recurrence during mid-term follow-up. However, owing to the absence of a control group, these findings should be interpreted as preliminary, and further prospective comparative studies with larger cohorts are needed to confirm its relative efficacy.