Natural history of hematospermia in 189 Japanese men.

OBJECTIVES: To prospectively investigate the natural history of hematospermia. METHODS: This study included 189 patients with hematospermia. All the patients underwent watchful waiting without any empirical treatment. RESULTS: The median observation period was 52 months. Hematospermia resolved spontaneously in 168 (88.9%) of the 189 patients, and the median disease duration was 1.5 months. Kaplan-Meier analysis showed that the persistence rates of hematospermia were 57.7% at 1 month, 34.2% at 3 months, 23.3% at 6 months, 12.5% at 1 year and 7.6% at 2 years. Hematospermia reoccurred in 20 (13.5%) of the 148 patients who had adequate follow up. The recurrence-free rates were 96.6% at 3 months, 89.0% at 1 year, 84.8% at 5 years and 78.2% at 10 years. Multivariate analysis showed that seminal vesicle hemorrhage and a midline cyst of the prostate were significant factors to predict the duration of hematospermia until spontaneous resolution. The nine patients with persisting hematospermia for more than 1 year were treated with transurethral endoscopic surgery (unroofing of the midline cyst in six, and transurethral resection of the ejaculatory duct in three), and hematospermia resolved postoperatively in all these patients. CONCLUSIONS: In patients with hematospermia without inflammation, infection or malignancy, it is important to provide information on the possibility that symptoms will resolve spontaneously and to implement measures to relieve their anxiety. Detection of seminal vesicle hemorrhage and a midline cyst of the prostate is important for prediction of the duration of hematospermia.

Hemospermia after transrectal ultrasound (TRUS)-guided prostatic biopsy: a prospective study.

Trans-rectal Ultrasound (TRUS) is a safe, cost-effective, radiation free imaging modality for evaluation of prostate. But unfortunately, hemospermia is known to be associated with TRUS -guided prostate biopsy. This study measured the incidence & risk factors, of hemospermia in patients undergoing trans-rectal ultrasonography (TRUS). A prospective observational study involving patients undergoing TRUS for suspected prostate cancer has been conducted at Al-Hussein and Sayed Galal, University Hospitals. 40patients were included in the study. The results showed that 18 out of 40 patients (45%) undergoing TRUS-guided prostatic biopsy, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 4 (+/- 1.4) weeks. The number of ejaculations before the complete resolution of hemospermia was 6 (+/- 5.6). None of the clinical and pathological factors were significant predictors of the duration of hemospermia.

Ectopic opening of cystic dilatation of the ejaculatory duct into enlarged prostatic utricle.

A 28-year-old man was referred to our department for the management of recurrent hemospermia during the past 5 years. Genital examination and hormonal levels were normal. Semen analysis showed no change in volume and pH; however, hemospermia and asthenozoospermia were observed. Ultrasonography and computed tomography scan revealed the presence of a cystic lesion with calcification in the terminal part of seminal vesicles adjoining the prostate gland. The following vasography and endoscopic retrograde urethrography demonstrated 2 communicating cystic dilatations arising from the verumontanum. The diagnosis of cystic dilatation of the ejaculatory duct opening into an enlarged prostatic utricle was reached. Transurethral unroofing of the cyst was separately performed with a successful outcome. The characteristic of the 2 cystic dilatations was confirmed by pathologic examination. To the best of our knowledge, this is the first case of ectopic cystic dilatation of the ejaculatory duct opening into an enlarged prostatic utricle.

Transrectal ultrasound-guided prostate biopsies in patients taking aspirin for cardiovascular disease: A meta-analysis.

INTRODUCTION: The management of anti-platelet therapy in the peri-operative period is a source of great concern. The dilemma is between whether to stop these agents peri-operatively in order to reduce the risk of bleeding complications, or to continue them in order not to compromise the protection they afford against the risk of cardiovascular events. MATERIALS AND METHODS: The aim of this systematic review and meta-analysis was to understand whether continued aspirin therapy is a risk factor for bleeding complications after ultrasound-guided biopsy of the prostate. A bibliographic search covering the period from January 1990 to May 2011 was conducted in PubMed, MEDLINE and EMBASE. We also included our own series in the analysis. RESULTS: A total of 3218 participants were included. Haematuria was statistically more frequent (P=0.001) among patients taking aspirin than in the control group with an odds ratio estimate of 1.36 [1.13;1.64]. This increased risk was, however, due to minor bleeding. The occurrence of rectal bleeding and haematospermia was not statistically increased (P=0.33 and P=0.24, respectively) in patients taking aspirin compared to in the control group with odds ratios estimate of 1.24 [0.80;1.93] and 1.52 [0.75;3.08], respectively. DISCUSSION: There is limited information of the relationship between continued use of aspirin and haemorrhagic complications after transrectal ultrasound-guided biopsy of the prostate. This is the first comprehensive analysis on this topic. CONCLUSION: Continued use of aspirin does not increase the risk of overall bleeding or moderate and severe haematuria after prostatic biopsy, and thus stopping aspirin before such biopsies is unnecessary.

Hemospermia in patients with congenital coagulation disorders: a study of three cases.

Hemospermia is usually a symptom of urological relevance, however it may have also a medical and hematological significance and has been reported in congenital or acquired bleeding disorders. Because of this symptom's negative psychological impact on the patient, it is likely that the condition is underplayed and therefore underdiagnosed. During the years 1967-2003 we had the opportunity to see 3 patients with hemospermia on a congenital bleeding disorder: a patient with hemophilia A, another with prothrombin deficiency and finally a patient with von Willebrand disease type I. All patients were heterosexual. In all instances the course was benign since it required administration of substitution therapy on only 2 occasions. Rest and abstinence from sexual activity appeared to be helpful. The first patient had other signs and symptoms compatible with the diagnosis of urethritis due to Escherichia coli and he underwent a course of antibiotic therapy. The other 2 cases appeared to be idiopathic since no associated condition was found. Urinary cytology, rectal examination, prostate sonography and prostate-specific antigen were normal in all cases. The rarity of hemospermia in congenital bleeding disorders remains unexplained, although the strong perineal and sphincter muscles may exercise a compressive hemostatic effect which could prevent or reduce bleeding.

Transrectal ultrasound- and fluoroscopic-assisted transurethral incision of ejaculatory ducts: a problem-solving approach to nonmalignant hematospermia due to ejaculatory duct obstruction.

PURPOSE: Ejaculatory duct obstruction (EJDO) has traditionally been managed with transurethral resection of ejaculatory ducts (TURED). However, wide resection has potential complications and risk of postoperative morbidity. We demonstrate a technique using transrectal ultrasonography (TRUS) and fluoroscopy to assist with transurethral incision of the ejaculatory duct (TUIED) to treat hematospermia due to obstruction by either a stone or a prostatic cyst. MATERIALS AND METHODS: Twenty-five patients with ejaculatory disorders including hematospermia underwent TUIED between 1997 and 2005. Diagnosis, the cause of hematospermia, and the level of EJDO was confirmed by semen analysis, semen culture, and TRUS. All patients were subjected to TRUS-guided seminal vesicle aspiration followed by seminal vesiculography using methylene blue mixed with contrast under biplanar TRUS guidance and fluoroscopic monitoring. After confirming the cause and level of obstruction, the ejaculatory duct was opened using endoscissors until the obstruction was relieved as confirmed by free flow of methylene blue. Stones were removed if any were present. A Foley catheter was kept in place for 24 hours. RESULTS: Improvement of symptoms was noted in 96% of patients with ejaculatory disorders. All patients with painful ejaculation and hematospermia had complete remission of symptoms at 3 months postoperatively; three patients had transient epididymo-orchitis, and none had retrograde ejaculation or incontinence. CONCLUSION: TUIED is a viable and minimally-invasive option for treating EJDO causing ejaculatory disorders including hematospermia with minimal morbidity and early recovery.