Hemangioma of the urinary tract is uncommon with the majority of cases located in the kidney, ureter or bladder [
1]. A number of cases of hemangioma occurring in prostatic urethra and presenting with hematuria, hematospermia or postejaculation urethral bleeding have also been reported [
2]. Hemangioma located exclusively in the prostate is extremely rare and only a few cases have previously been reported [
3,
4]. Sundarasivarao et al. reported a case where the patient presented with chronic urine retention and the diagnosis of prostatic hemangioma was only made after prostatic enucleation [
3]. Rivoir and Kaslaris reported a case of prostatic hemangioma in a 65-year-old patient with five years history of nocturia and a single episode of temporary retention of urine. Cystoscopy showed bladder trabeculation and severely injected bladder mucosa. The urine contained a large number of erythrocytes. The patient was subjected to perineal intracapsular prostatectomy, which was complicated by intraoperative uncontrollable bleeding which despite packing and use of spongostan resulted in the patient's death the day after operation. Histology showed capillary hemangioma [
4]. Whereas diagnosis of prostatic hemangiona is relatively straightforward for the pathologist, it poses a diagnostic and therapeutic challenge to the urologist. Prostatic hemangioma has no specific clinical features apart from hematuria and heamtospermia, which can occur in many other conditions. If prostatic hemangioma presents as LUTS, as it has done in the present case, the only feature that distinguishes it from benign prostate hyperplasia is association of unexplained hematuria or hematospermia. Prostatic hemangioma can be suspected at cystoscopy by visualization of bluish red areas in the bladder or prostatic urethra [
2,
5]. A transrectal power Doppler ultrasonography is a useful tool in diagnosing prostatic hemangioma in patients with unexplained hematospermia and/or hematuria, but we do not consider it useful in routine clinical practice unless cystoscopy suggests the presence of a hemangioma [
2]. Perhaps Doppler ultrasonography using contrast could be even more helpful showing the typical wash in wash out pattern seen in hemangiomas in the liver, but that remains to be examined. Routine rectal ultrasound used to measure prostatic volume did not reveal the presence of a hemangioma in our patient. A definitive preopertative diagnosis can usually be achieved through arteriography of the internal iliac arteries [
6]. Treatment of hemangioma in the bladder and prostate has varied from electrocautery, Nd-YAG laser to radiation or in cases of periprostatic hemangioma with selective arterial embolization [
5,
7,
8]. In our case hemangioma was located in the prostatic tissue. The symptoms and the urodynamic investigations were similar to those of infravesical outflow obstruction. Cystoscopy did not reveal any discoloration in the prostatic urethra or on prostatic lobes. The patient was treated as a case of prostatic hyperplasia with transurethral resection. The patient developed postoperative retention of urine and this was thought to be due to detrusor insufficiency and therefore a period of conservative treatment with self-cathererization was adopted. Prostatic hemangioma presenting as LUTS can be treated as an ordinary symptomatic prostatic enlargement by transurethral resection or other modalities such as laser evaporation. Symptomatic prostatic hemangioma if diagnosed preoperatively should be treated with TURP. We have no evidence that laser or bipolar evaporation are superior to a classic TURP. Nevertheless one might choose to use laser or bipolar techniques if possible. If a prostataic hemangioma is discovered during a TURP we recommend one should carry on with a careful transurethral resection of prostate, alternatively one could convert the procedure to laser or bipolar technique if possible. One should be cautious in performing open prostatectomy in the case of symptomatic prostatic hemangioma because of risk of undue bleeding [
4]. To our knowledge hemangioma's never become malignant, but after partial removal some regeneration with growth may occur.