The clinical signs are limited to hematuria at the end of urination, associated with contractions of the bulbourethral muscle in geldings or with hemospermia and decreased fertility in stallions. All breeds may be affected, although the disorder seems more common in Quarter horses.
Diagnosis is based on clinical signs and urethral endoscopic findings. The urethral defect is seen in most cases on the dorsal convex surface of the urethra at the level of the ischial arch.
Some cases may heal spontaneously, but most continue with intermittent hemorrhage; anemia is rare. Breeding rest is recommended for stallions. Subischial urethrostomy or subischial incision into the spongiosum penis reduces vascular pressure in the corpus spongiosum during urination, allowing the defect to heal. A buccal mucosal graft was used to repair the defect in a stallion.