Background: Urethrorrhagia characterized by terminal hematuria and/or bloody spotting of the undershorts between episodes of voiding is not an uncommon problem of childhood. We describe a series of boys with urethrorrhagia and associated clinical and endoscopic findings.
Methods: A total of 67 records of boys from 1990-2005 with idiopathic urethrorrhagia were retrospectively reviewed for information regarding age, symptoms, symptom duration, physical examination, radiographic, endoscopic and laboratory data.
Results: Sixty-seven patients met the criteria for inclusion in the present series. A total of 48 (72%) patients presented with either blood spotting of the underwear and terminal hematuria. In addition, 14 patients (21%) presented with meatal stenosis and 34 patients (50%) presented with dysuria. Endoscopic evaluation was performed in 55 (82%) patients for prolonged symptomatology or recurrent disease. Cystoscopic evaluation of patients with recurrent and severe symptomatology revealed four distinct findings. Group 1 included 2 patients (4%) with a normal appearing urethra. Group 2 consisted of 26 (47%) patients who were found to have inflammation or hyperemia of the bulbar urethra. Group 3 included 16 (29%) cases in which there was a white membranous exudate or mucosal irregularity with nearby excoriation or ulceration. Group 4 included 13 (24%) patients who were found to have stricture disease on cystoscopy. In 8 cases, stricture was present on initial cystoscopy with no history of prior instrumentation. Stricture developed after initial cystoscopy in 5 cases, of those 3 had evidence of white membranous exudates on initial endoscopy described previously.
Conclusions: A subset of these patients with urethrorrhagia develops urethral stricture disease. Due to the fact that 8 (12%) strictures were present on first cystoscopy, we feel that uroflow and endoscopy are important tools for the work-up of severe and persistent cases of urethrorrhagia. In addition, those patients in Group 3 may represent a unique at risk population. It is our theory that the white membranous exudate found on cystoscopy may represent a potential pre-stricture lesion as evidenced by those three cases that developed strictures subsequently. Therefore, those patients in Group 3 may warrant closer follow-up and evaluation for stricture disease.

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