hemospermie

Haematospermia : 

Haematospermia Gordon Smyth SpR Teaching Feb 14th 2005

Introduction : 

Introduction Haematospermia refers to the presence of blood in the seminal fluid Provokes great anxiety in patients Fearful of cancer, STDs, threat to sex life Aetiology diverse and poorly understood Prevalence in general population and incidence in GUM settings unknown Incidence in urology 1:5000 new cases Leary et al. Mayo Clinic Proc. 1974

Introduction : 

Introduction Can occur in men of any age (mean 37 years) Site of origin could be prostate, seminal vesicle, testes, epididymis, vas deferens, urethra, bladder Usually: acute onset Recurrent Self limiting (usually resolves within several weeks) Rarely: Severe, postcoital haematuria, clot formation

Introduction : 

Introduction May be only symptom or associated with other urological symptoms such as dysuria, testicular pain, prostatism, heamaturia Emission and ejacualation must be present Erection is not necessary

Aetiology : 

Aetiology Inflammation Iatrogenic (Prostate needle biopsy) Vascular abnormalities Ductal obstruction or cysts Tumours Systemic disease Drugs

Aetiology : 

Aetiology Relative frequency with which definite pathology is detected is directly related to degree of investigation Most due to inflammation, infection and iatrogenic Malignancy is rare but should be considered in patients >40 years

Leary et al. Clinical significance of haematospermia. Mayo Clin Proc 1974;49:815-17 : 

Leary et al. Clinical significance of haematospermia. Mayo Clin Proc 1974;49:815-17 Review of 200 patients, 15 years Physical exam, DRE, MSU all patients 174 cysto and KUB 64 patients minor abnormalities No incidence of significant urological disease 150 patients followed for 5 – 23 years 44 persistent haematuria None developed any significant disease

Fletcher et al. The aetiology and investigation of haematospermia. Br J Urol 1981;53:669-71 : 

Fletcher et al. The aetiology and investigation of haematospermia. Br J Urol 1981;53:669-71 81 patients 1976-1980 Physical exam, DRE in all Further tests included prostatic massage, MSU, AFB, seminal analysis, IVU, cysto and prostate biopsy as indicated 86% cause was discovered 80% of these cause was infection (esp <30 years) 6 cases of prostate neoplasia discovered, all over 40 yrs

Weidner et al. Recurrent heamatospermia-underlying urogenital anomalies and efficacy of imaging procedures. Br J Urol 1991; 67:317-23 : 

Weidner et al. Recurrent heamatospermia-underlying urogenital anomalies and efficacy of imaging procedures. Br J Urol 1991; 67:317-23 72 patients (mean age 38 (19-72)) Retrospective All had physical exam, MSU, semen analysis, TRUS, cystoscopy, CT scan TRUS biopsy when indicated 75% found associated factor 50% of these was infection One patient with CaP (72 year old)

Jones et al. Haematospermia: a prospective study. Br J Urol 1991;67:88-90 : 

Jones et al. Haematospermia: a prospective study. Br J Urol 1991;67:88-90 Prospective 74 men, 6 year period Physical exam, MSU, seminalysis, KUB, cystoscopy Group 1: <40 years (n=65) 31 pts no abnormalities 34 pts, infection most common No malignancy Group 2: >40 years (n=9) cause found in all pts one CaP age 73 years

Papp et al. Haematospermia. J Androl 1994;15 Suppl:31S-33S : 

Papp et al. Haematospermia. J Androl 1994;15 Suppl:31S-33S N=84 Progressive diagnostic approach Physical examination, semen analysis, TRUS, CT, MRI, vasography, voiding urethrography Most frequent finding is prostatic disease (41.6%) Especially prostatic calculi (20.2%) Malignant disease in 11.8% Unexplained in 15.4%

Conclusion : 

Conclusion Most cases benign and self-limiting Most patients <40 years conservative Mx If pathology identified, treat accordingly No conclusive evidence re: surveillance Refer to urology if: >40 years Recurrent or persistent Associated symptoms or very worried