Herein, we introduced tertiary referral hospital experiences of men presenting with painless PCGH and tried to suggest a tentative management algorithm.METHODS: Between 2009 and July 2016, data from 20 first-visit patients with PCGH were reviewed.After checking present illness and past history, further studies were performed by our tentative management algorithm for painless PCGH (Figure 1).At first, the general work-up for painless gross hematuria including laboratory test, CT, and urethrocystoscopy was performed.If no discernable reason for PCGH was identified, the focused work-up of PCGH for pelvic vasculatures was carried out as follows.Transrectal and penile ultrasonogrphay (USG) with Doppler study were performed for the evaluation of prostate, penis, and their relevant vasculatures.Diagnostic pelvic angiography and subsequent angioembolization were recommended at the physician 0 s discretion.RESULTS: The median age was 47 years (31 ~67).After following of our tentative algorithm, there was no abnormal finding in 9 (45.0%),urological malignancies were found in 2 (10.0%; 1 bladder, 1 kidney).On urethrocystoscopy, urethral mucosal bulging suggestive of hemangioma was found in 3 (15.0%)(Figure 2A).Doppler USG revealed pelvic varicosities in 3 (15.0%),and pelvic arteriovenous malformation (AVM) in 3 (15.0%)(Figure 2B, C).Pelvic angiography was recommended to the latter 3 patients for confirmatory diagnosis.One refused angiography, but the other 2 patients underwent angiography and subsequent angioembolization for AVM (Figure 2D ~F).CONCLUSIONS: PCGH is a different disease entity from painless GH.The focused work-up for the pelvic vasculatures seems to be mandatory for the evaluation of these patients.The feasibility of our tentative algorithm should be evaluated by well designed clinical studies.
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Rosen et al. (2017) studied this question.