Hemangiomas are benign proliferations of blood vessels, and urethral hemangiomas are extremely rare presentations of this condition. As the condition is quite rare, there is very little literature about best management strategies. The best resources for determining management are case reports which focus on treatment via transurethral ablation or endoscopic resection. However, there is no guidance on management of urethral hemangiomas which are refractory to these minimally invasive methods. Herein, we summarize the literature for urethral hemangioma management, present the case of a male presenting with refractory hematuria due to a hemangioma in the penile urethra, and describe the operative technique for the open excision and reconstruction of this hemangioma.