Advertisement

Purpose:

With current diagnostic modalities the proportion of patients diagnosed with idiopathic hemospermia has decreased dramatically. The dilemma now is how far to investigate these patients since in the majority it is a benign and self-limiting symptom.

Materials and Methods:

We reviewed the literature on hemospermia with particular emphasis on etiology, diagnosis and management. A Medline® search of the literature for the last 40 years was done and all relevant articles were studied in full.

Results:

Etiological factors are often categorized into the various pathophysiological mechanisms. Most cases of hemospermia are the result of iatrogenic, inflammatory and infective pathologies. A literature review of the etiological studies of hemospermia identified a total of 33 tumors (25 prostatic) in 931 cases (3.5%). In patients younger than 40 years an infective cause in the urogenital tract is the most common etiological factor. Often only simple, tailored investigations and appropriate treatment are required. In patients older than 40 years with persistent hemospermia or associated symptoms such as hematuria it is essential to exclude urogenital malignancy. History, examination and simple investigation should also suffice in this group. If the diagnosis is still unclear, further investigation in the form of transrectal ultrasound, magnetic resonance imaging and cystoscopy is of proven benefit. Treatment for hemospermia depends on the underlying pathological condition. In most cases bleeding is slight and self-limited, and it may be managed expectantly.

Conclusions:

The majority of patients can be treated with minimal investigations and simple reassurance. In older patients or those with persistent hemospermia or associated symptoms modern diagnostic techniques are of proven benefit.

References

  • 1 : Hemospermia. J Urol1983; 129: 377. LinkGoogle Scholar
  • 2 : Haemospermia. Br J Urol1992; 69: 225. Google Scholar
  • 3 : Association of hemospermia with prostate cancer. J Urol2004; 172: 2189. LinkGoogle Scholar
  • 4 : Hemospermia: a prospective study. Br J Urol1991; 67: 88. Google Scholar
  • 5 : Hemospermia: diagnosis and management. Urology1995; 46: 463. Google Scholar
  • 6 : Clinical study of hemospermia. Urology1977; 10: 562. Google Scholar
  • 7 : Clinical significance of hematospermia. Mayo Clin Proc1974; 49: 815. Google Scholar
  • 8 : Aetiology of haemospermia. Andrologia2003; 35: 317. Google Scholar
  • 9 : Current perspectives on hematospermia: a review. J Androl1997; 18: 6. Google Scholar
  • 10 : The aetiology and investigation of haemospermia. Br J Urol1981; 53: 669. Google Scholar
  • 11 : Chronic hematospermia: assessment by transrectal ultrasound. Urology1994; 43: 515. Google Scholar
  • 12 : Infection by human cytomegalovirus associated with chronic hematospermia. Urology1983; 22: 617. Google Scholar
  • 13 : Genitourinary mycobacteria in infertile Egyptian men. Fertil Steril1990; 54: 713. Google Scholar
  • 14 : Hematospermia: a new etiology of clinical interest. Am J Trop Med Hyg1994; 50: 580. Google Scholar
  • 15 : Detection of sexually transmitted pathogens in patients with hematospermia. Isr Med Assoc J2005; 7: 224. Google Scholar
  • 16 : Hemospermia owing to utricular cyst: embryological summary and case review. J Urol1983; 129: 608. AbstractGoogle Scholar
  • 17 : Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction. J Urol1993; 150: 1150. LinkGoogle Scholar
  • 18 : Chronic hemospermia due to mullerian duct cyst: diagnosis by magnetic resonance imaging. J Urol1989; 142: 828. AbstractGoogle Scholar
  • 19 : Polyps and papillary lesions of the prostatic urethra. Pathology1983; 15: 153. Google Scholar
  • 20 : Adenomyosis of the seminal vesicle with hematospermia. Hinyokika Kiyo1993; 39: 73. Google Scholar
  • 21 : Seminoma in the testes associated with haemospermia. BJU Int2002; 89: 633. Google Scholar
  • 22 : Hemospermia: review of the management with 5 years follow-up. J Med Assoc Thai2001; 84: 1518. Google Scholar
  • 23 : Retrospective study of 107 patients with hematospermia. Hinyokika Kiyo1997; 43: 103. Google Scholar
  • 24 : Hematospermia. J Androl1994; 15: 31S. Google Scholar
  • 25 : Haemospermia: how to proceed?. Ir J Med Sci1993; 162: 173. Google Scholar
  • 26 : Recurrent haemospermia—underlying urogenital anomalies and efficacy of imaging procedures. Br J Urol1991; 67: 317. Google Scholar
  • 27 : Hemospermia. Urology1975; 6: 331. Google Scholar
  • 28 : Massive hemospermia: a new etiology and simplified treatment. J Urol1982; 128: 151. LinkGoogle Scholar
  • 29 : Hematospermia in an adolescent. J Adolesc Health Care1989; 10: 554. Google Scholar
  • 30 : Cavernous hemangioma of the spermatic cord. Hinyokika Kiyo1994; 38: 591. Google Scholar
  • 31 : The association between haemospermia and severe hypertension. Postgrad Med J1991; 67: 157. Google Scholar
  • 32 : Case report: recurrent hematuria and hematospermia due to prostatic telangiectasia in classic von Willebrand’s disease. Am J Med Sci1993; 306: 35. Google Scholar
  • 33 : Haemospermia as a presenting symptom of lymphoma. Br J Urol1990; 66: 658. Google Scholar
  • 34 : Complications following combined transrectal biopsy and core biopsy of the prostate. Scand J Urol Nephrol1990; 24: 249. Google Scholar
  • 35 : Treatment of chronic bacterial prostatitis by local injection of antibiotics into prostate. Urology1983; 21: 370. Google Scholar
  • 36 : High intensity focused ultrasound for the treatment of benign prostatic hyperplasia: early United States clinical experience. J Urol1994; 151: 1271. LinkGoogle Scholar
  • 37 : “3-in-1” Nerve block complicated by haemospermia. Br J Clin Pract1992; 46: 80. Google Scholar
  • 38 : Melanospermia: an unusual presentation of malignant melanoma. J Urol1973; 110: 314. LinkGoogle Scholar
  • 39 : Transrectal ultrasonography of the prostate and seminal vesicles with hemospermia. Urol Int1994; 53: 139. Google Scholar
  • 40 : Haematospermia: in the context of a genitourinary medicine setting. Int J STD AIDS2002; 13: 517. Google Scholar
  • 41 : Transrectal ultrasound in the investigation of haemospermia. Clin Radiol1990; 41: 175. Google Scholar
  • 42 : Efficacy of transrectal ultrasonography in the evaluation of hematospermia. Clin Imag2004; 28: 286. Google Scholar
  • 43 : Magnetic resonance images of hematospermia. Urology1993; 41: 499. Google Scholar
  • 44 : Endorectal coil MR imaging findings in hemospermia. MAGMA1999; 8: 91. Google Scholar
  • 45 : Hematospermia: an investigation of the bleeding site and underlying lesions. Int J Urol1999; 6: 539. Google Scholar
  • 46 : Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography. J Urol1988; 140: 991. LinkGoogle Scholar
  • 47 : Endourologic management of the seminal vesicle cyst. J Endourol1994; 8: 429. Google Scholar
  • 48 : Laparoscopic approach to seminal vesicles. J Urol1993; 150: 417. AbstractGoogle Scholar
  • 49 : Urethral verumontanal polyp: evidence of prostatic origin. Urology1984; 24: 499. Google Scholar

Department of Urology, Ayr Hospital, Ayr, Scotland, United Kingdom

Advertisement