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Hematospermia Clinical Presentation: Causes


The aim of the present study was to describe transrectal ultrasound (TRUS)‑guided seminal vesicle catheterizations with continuous antibiotic infusion in patients with persistent hematospermia. A retrospective record review of 45 patients with refractory hematospermia treated with TRUS‑guided seminal vesicle catheterization between 2010 and 2017 was performed. Seminal vesicle puncture and catheterization was performed under TRUS guidance for all patients. Antibiotic irrigation was used to rinse the seminal vesicle until the outflow fluid was clear. The trocar sleeve was left in situ and fixed on the skin of the perineum at the end of the procedure. All patients underwent a 24‑h continuous infusion of antibiotic solution through the catheter. The patients were followed up to 3 years for the presence of hematospermia. The duration of refractory hematospermia was between 6 months and 9 years. A total of 14 patients exhibited consecutive hematospermia, while the remaining patients exhibited intermittent episodes. On TRUS, 15 cases of ejaculatory duct cyst, 7 cases of ejaculatory duct expansion, 3 cases of ejaculatory duct stones, 6 cases of seminal vesicle expansion, 8 cases of seminal vesicle stones and 5 cases of seminal vesicle wall or ejaculation wall calcification were diagnosed. A total of 41 patients completed the scheduled treatment plan; however, the catheter was dissociated on the 3rd or 4th day of catheterization in 4 patients. After a 1‑3 year follow‑up, hematospermia was not observed in 42 patients (93.33%) with recurrence in the remaining 3 patients. In conclusion, TRUS‑guided seminal vesicle catheterization with continuous antibiotic infusion appeared to be a safe and effective method for the treatment of hematospermia.To get more news about Seminal vesiculitis cause hemospermia, you can visit our official website.
Hematospermia is a common symptom in urology, which is defined as visible blood in the ejaculate (1,2). It is commonly seen in patients <40 years old with a worldwide prevalence of one case per 5,000 urological patients (1). The exact prevalence of the condition is difficult to determine as only a few men examine their ejaculate and even less report to a clinician for a consultation (3). Hematospermia can be an isolated condition or can occur with other symptoms such as hematuria, dysuria and/or scrotal pain (3,4). It may occur only once in a life-time of an individual or can be periodic and chronic (3-5).

Hematospermia is usually benign and a self-healing condition that is less frequently associated with a underlying pathological process (5). The etiology of hematospermia is often not known in >70% cases; however, with advances in diagnostic technologies, the causes of hematospermia are more readily recognized (1). Persistent or recurrent hematospermia is often caused by non-specific inflammation or infection of the lower urinary tract, especially seminal vesiculitis and prostatitis (3,4). In some cases, pathologies such as benign urethral tumor or seminal vesicle malignancy may also present as hematospermia (5,6).

A thorough clinical work-up including the patients' medical history, sexual history, blood biochemistry, physical examination and examination of the ejaculate is recommended for assessing all patients presenting with the condition (6). In the majority of cases, hematospermia resolves without any treatment and in patients without any underlying cause of risk factors, only reassurance is sufficient to alleviate the patients anxiety (1,5,6). In the remaining patients, management of hematospermia depends on the underlying cause. In cases of infections, empirical administration of antibiotics often treat the condition successfully (4). Surgical treatment may be required in cases of pathological abnormalities like cysts, vascular anomalies or calcifications (6). While the majority of patients with hematospermia are cured in a short period of time, a small number of patients relapse with persistent symptoms, and the management of these patients can be challenging (3).

Recent advances in the field of minimally invasive surgery has led to development of trans urethral seminal vesiculoscopy for the management of recurrent hematospermia (7). However, limitations of this technique include the degree of difficulty involved with the procedure and the surgical experience required (8). A simpler technique involving image-guided puncture of seminal vesicles and irrigation with antibiotic solution has received limited attention in literature (1,5). The current study presents the results of the use of transrectal ultrasound (TRUS)-guided seminal vesicle catheterizations with continuous antibiotic infusion for the treatment of patients with persistent hematospermia.