今日の臨床サポート

血精液症

著者: 井上貴昭1) 原泌尿器科病院

著者: 松田公志2) 関西医科大学 泌尿器科学教室

監修: 松田公志 関西医科大学 泌尿器科学教室

著者校正済:2022/07/06
現在監修レビュー中
患者向け説明資料

概要・推奨   

  1. 血精液症を伴う多くの患者は、病院を受診する以前に1~2回の血精液症のエピソードを経験していることが多い。40歳未満の患者は良性であった(推奨度2)
  1. 血精液症は泌尿器科癌(前立腺癌)に現れる初期症状の場合もある。特に50歳以上の男性に関しては注意が必要であり、それらを念頭に置いた診察・検査が不可欠である(推奨度1)
  1. 血精液症の患者に対するアプローチで大切なのは、まず詳細な問診である。次に身体所見(特に会陰部)を詳細に診察する必要がある。直腸診は直腸や前立腺のmassなどを除外するため、すべての患者に実施されるべきであろう(推奨度1)
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
井上貴昭 : 特に申告事項無し[2022年]
松田公志 : 講演料(アステラス製薬株式会社),奨学(奨励)寄付など(小野薬品工業株式会社)[2022年]
監修:松田公志 : 講演料(アステラス製薬株式会社),奨学(奨励)寄付など(小野薬品工業株式会社)[2022年]

改訂のポイント:
  1. 定期レビューを行い、新しい研究結果を追記した。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 血精液症は従来、射精した精液のなかに肉眼的に確認できる血液が存在することと定義されている。
  1. 1894年に、Huguesらが血精液症について報告したのが最初である。この症状は比較的まれであり、短期間で消失することも多く、self-limitingな場合も多い。そのため、血精液症を持つ男性患者の77.5%は、泌尿器科を受診する前に1~2回の血精液症のエピソードを経験していることも少なくない。
  1. しかし、正常男性にとって血精液症が繰り返されることは不安を駆り立てる要因である。多くの血精液症の原因は良性であるが、まれにこの症状が泌尿器科癌に現れる最初の症状の場合もある。Hanらは、50歳以上の男性2万6,126人に前立腺癌のスクリーニング検査を行い、139人(0.5%)に血精液症の既往を認めたと報告し、その血精液症の既往を持つ男性のうち19人(14%)が前立腺癌であったと報告している。
  1. 近年の画像技術の急速な進歩により、今まで特発性血精液症と診断されてきた多くの症例が劇的に減少すると考えられる。しかし、血精液症の患者を詳細に評価したような研究報告はあまり多くない。今もなお、このような血精液症の患者の原因をどのように調べればいいのかという課題は残っている。
 
  1. 血精液症を伴う多くの患者は、病院を受診する以前に1~2回の血精液症のエピソードを経験していることが多い。40歳未満の患者は良性であった(推奨度 2o(参考文献:[1]
  1. まとめ:若年者の血精液症の多くは良性であると考えられている。
  1. 代表事例:血精液症を伴う74人の男性のうち、多くの患者(76%)は、病院を受診するまでに1~2回の血精液症のエピソードを経験していた。40歳未満の患者65人のうち、31人は異常なしで、残りの34人も良性であり、そのうちの32人は単純な検査のみで診断がついた。これら65人のうち、56人(86%)は3カ月の経過観察で改善した。
  1. 結論:血精液症を伴う若年者の多くは良性であり、多くは単純な検査のみで診断可能であった。その多くは3カ月以内に改善を期待できた。
 
  1. 血精液症は泌尿器科癌(前立腺癌)に現れる初期症状の場合もある。特に50歳以上の男性に関しては注意が必要であり、それらを念頭に置いた診察・検査が不可欠である(推奨度 1R(参考文献:[2]
  1. まとめ:前立腺癌スクリーニング検査において血精液症はとてもまれな症状(0.5%)であるが、血精液症を認めた患者のうち13.7%に前立腺癌を認めた。
  1. 代表事例:Hanらは、50歳以上の男性(そして前立腺癌家族歴を持つ40歳以上の男性)2万6,126人に対して前立腺癌スクリーニング検査(血清PSA検査、直腸診)を行った。そのすべてで、血精液症について記載した質問票を取った。結果、2万6,126人中、前立腺癌と診断されたのは1,708人(6.5%)であった。このスクリーニング検査を実施した男性のうち139人(0.5%)に血精液症の既往を認め、そのうちの19人(13.7%)が前立腺癌と診断された。ロジスティック回帰分析において、年齢、PSA、直腸診で補正したところ、血精液症は前立腺癌を予期する要因であった(OR 1.73、p=0.054)。
  1. 結論:血精液症は前立腺癌スクリーニング検査においてまれな症状ではあるが、前立腺癌のリスクを上げる要因でもあり、注意深い診察が必要である。
  1. 追記:血精液症以外に下部尿路症状(排尿困難、頻尿など)を認める場合や血尿を認める場合には、泌尿器科癌の可能性を十分に念頭に置く必要がある。
 
問診・診察のポイント  
 
  1. 血精液症患者への診断アプローチは、治療可能な原因疾患を見逃さないために系統的に行われるべきである。原因疾患は多岐にわたるため、全身的な検索が必要となってくる。

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文献 

D J Jones
Haemospermia: a prospective study.
Br J Urol. 1991 Jan;67(1):88-90.
Abstract/Text A prospective study of 74 men with haemospermia is presented. Most (76%) had experienced 1 or 2 episodes only and 9 (12%) were over 40 years old. Simple investigations led to a diagnosis in all 9 of these men and of those under 40, no pathology could be detected in 48%. A diagnosis was made in 32 of the remaining 34 men by simple investigations. In patients over 40 years of age with haemospermia, a potentially treatable cause will normally be found by routine investigation which should include cystoscopy. In younger men, non-invasive investigation alone should identify any pathology. Invasive investigations should be reserved for those patients in whom the problem is prolonged, excessive or in association with other symptoms.

PMID 1704278
Misop Han, Robert E Brannigan, Jo Ann V Antenor, Kimberly A Roehl, William J Catalona
Association of hemospermia with prostate cancer.
J Urol. 2004 Dec;172(6 Pt 1):2189-92.
Abstract/Text PURPOSE: Hemospermia is uncommon clinical condition that usually follows a benign course. The association between hemospermia and prostate cancer has been reported but to our knowledge not thoroughly investigated. We studied the incidence of hemospermia and the association between prostate cancer and hemospermia in a large prostate cancer screening population.
MATERIALS AND METHODS: Between 1991 and 2001, 26,126 ambulatory men 50 years or older (40 years or older with a family history of prostate cancer or black race) underwent a community based prostate cancer screening study using serum prostate specific antigen (PSA) and digital rectal examination (DRE). PSA measurement and DRE were repeated at 6-month or 1-year intervals depending on PSA for the remainder of the study. Men underwent prostate biopsy due to increased serum PSA (greater than 4.0 ng/ml until May 1995 or greater than 2.5 ng/ml after May 1995) or suspicious DRE. Men with a history of prostate cancer were excluded from study. Men completed a questionnaire, including information about hemospermia, at each screening visit. Hemospermia information from the initial questionnaire was analyzed. The relative risk of prostate cancer diagnosis in the overall prostate cancer screening population and the cohort with hemospermia was determined. Detailed prostate cancer characteristics were evaluated in those who had hemospermia and underwent radical prostatectomy. We used a multivariate logistic regression model to test the independent significance of hemospermia after adjusting for other known predictors of prostate cancer detection.
RESULTS: Prostate cancer was detected in 1,708 of the 26,126 men (6.5%) who underwent prostate cancer screening. Prostate cancer was diagnosed in 19 of the 139 men (13.7%) who reported hemospermia upon entering the prostate cancer screening study. The median age of the 139 men was 61 years (range 40 to 89). Ten of the 13 men who underwent radical retropubic prostatectomy had stage pT2 disease, while 3 had stage pT3 disease. In the logistic regression model hemospermia was a significant predictor of prostate cancer diagnosis after adjusting for age, PSA and DRE results (OR 1.73, p = 0.054).
CONCLUSIONS: Hemospermia is rare (0.5%) in a prostate cancer screening population. When a man presents with hemospermia, prostate cancer screening should be vigilantly performed since hemospermia is associated with an increased risk of prostate cancer.

PMID 15538229
R Munkel witz, S Krasnokutsky, J Lie, S M Shah, J Bayshtok, S A Khan
Current perspectives on hematospermia: a review.
J Androl. 1997 Jan-Feb;18(1):6-14.
Abstract/Text Hematospermia is a disconcerting symptom that produces extreme anxiety in sexually active male patients. To understand the pathophysiology of hematospermia, the anatomy of the ejaculatory system and neurophysiology of emission and ejaculation is essential. Emission and ejaculation must be present for hematospermia to occur. Hematospermia may be the result of inflammation, infection, ductal obstruction or cysts, neoplasms, vascular abnormalities, and systemic or iatrogenic factors. Most patients promptly consult a urologist after an episode of hematospermia. History and physical examination are often unrevealing and the judicious use of imaging modalities, such as transrectal ultrasound, MRI, and rigid or flexible endoscopy may be diagnostic. Unless the specific etiology is defined, most cases are managed expectantly. We review the etiology of hematospermia and an algorithm is provided for the diagnosis and management.

PMID 9089062
Imran Ahmad, Nalagatla Sarath Krishna
Hemospermia.
J Urol. 2007 May;177(5):1613-8. doi: 10.1016/j.juro.2007.01.004.
Abstract/Text 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.

PMID 17437771
Cemil Yagci, Sadettin Kupeli, Cisel Tok, Suat Fitoz, Sumer Baltaci, Orhan Gogus
Efficacy of transrectal ultrasonography in the evaluation of hematospermia.
Clin Imaging. 2004 Jul-Aug;28(4):286-90. doi: 10.1016/S0899-7071(03)00157-8.
Abstract/Text OBJECTIVE: To assess the efficacy of transrectal ultrasonography (TRUS) in the evaluation of hematospermia.
MATERIAL AND METHODS: This study included 54 patients with hematospermia. Patients age range was between 25 and 75 years (mean=49.7 years). All patients were evaluated by TRUS using a biplane transducer and a Toshiba SSA-270A device.
RESULTS: TRUS revealed one or more abnormalities in 51 patients (94.5%). Prostatic calcifications were found in 23 patients, ejaculatory duct calculi in 21, dilated ejaculatory ducts in 18, benign prostatic hyperplasia in 18, dilated seminal vesicles in 12, calcifications in seminal vesicles in 11, ejaculatory duct cyst in 6, prostatitis in 6, and periurethral Cowper gland mass in 1.
CONCLUSION: TRUS is a noninvasive, safe method for the investigation of causes of hematospermia. We believe that it should be the first radiological investigation to be performed in patients presenting with hematospermia.

PMID 15246480
H Maeda, N Toyooka, T Kinukawa, R Hattori, T Furukawa
Magnetic resonance images of hematospermia.
Urology. 1993 May;41(5):499-504.
Abstract/Text Seminal vesicles and their adjacent structures were studied using magnetic resonance imaging (MRI) in 7 normal volunteers and 15 patients with hematospermia. Normal seminal vesicles are depicted on T2-weighted images either as a mixture of high- and low-signal granules or as a convolution of tubules with a diameter of less than 0.5 cm. Fourteen of the 15 patients with hematospermia exhibited abnormalities on MRI. Dilatation or cyst formation in the seminal vesicle was observed in 13 patients, and a dilatation of the midline structure was seen in 3 patients. Abnormal signal intensity of the seminal vesicles was seen in 11 patients and was thought to be due to subacute hemorrhage.

PMID 8488623
Michael J Mathers, Stefan Degener, Herbert Sperling, Stephan Roth
Hematospermia-a Symptom With Many Possible Causes.
Dtsch Arztebl Int. 2017 Mar 17;114(11):186-191. doi: 10.3238/arztebl.2017.0186.
Abstract/Text BACKGROUND: Hematospermia, or blood in the ejaculate, is a symptom with many possible causes that often gives rise to worry. Precise figures on its prevalence are unavailable. It is most common in men under 40, and its cause is usually benign; nonetheless, even a single episode of hematospermia calls for a basic diagnostic evaluation.
METHODS: This review is based on pertinent articles re trieved by a search in PubMed with the key words "hemato spermia," "hemospermia," "ejaculation," "male semen," and "transrectal ultrasound."
RESULTS: A diagnostic algorithm for hematospermia is described. The most common cause is iatrogenic trauma, in particular transrectal ultrasound-guided prostate biopsy to rule out prostate cancer. Urogenital infections are the second most common cause. Pathological changes of the prostate should be considered along with systemic causes, e.g., arterial hypertension or various hematologic disorders. A single event in men under 40 should be evaluated by precise history-taking, a meticulous physical examination including blood-pressure measurement, and urinalysis. Repeated episodes, or hematospermia in men over 40, calls for additional evaluation with further laboratory tests, imaging studies, and, in some cases, interventional diagnostic procedures.
CONCLUSION: Further tests, preferably imaging studies, seem a reasonable way to detect or exclude potential causes of hematospermia, especially malignant ones. The treatment is directed at the underlying cause.

PMID 28382905
G K Papp, Z Kopa, F Szabó, E Erdei
Aetiology of haemospermia.
Andrologia. 2003 Oct;35(5):317-20.
Abstract/Text There are several unknown factors which cause haemospermia. An earlier developed diagnostic scheme has been expended by novel imaging techniques and biopsy methods. A detailed case history, physical examination and microscopic analysis of the ejaculate is required. In haemo-pyospermia a complete microbiological analysis must be escalated. Noninvasive imaging techniques (ultrasound, computer tomography and magnetic resonance imaging) help in detecting calculous and malignant diseases. So far, as a precise diagnosis has not been available, urethroscopy has been performed. Malignancies (prostate, seminal vesicles) must be histologically verified by biopsies. In contempt of our efforts the practice shows a part of haemospermia remaining essential. Analysing two time periods we found prostatic calculi, chronic prostatitis and carcinoma of the prostate unequivocally as most frequent causes. Considering the rare genital malignancies we find more than 10% frequency. Notably, in our study only 2.4% of the malignancies occurred in patients under 40 years of age. Hence a detailed diagnosis is advocated in haemospermia patients over 40 years. Finally, we may state that in contempt of the applied modern imaging techniques 15% of patients with haemospermia had unknown aetiology.

PMID 14535863
Xin-ru Zhang, Bao-jun Gu, Yue-min Xu, Rong Chen, Jiong Zhang, Yong Qiao
Transrectal ultrasonography-guided transperineal bilateral seminal vesicle puncture and continuous irrigation for the treatment of intractable hematospermia.
Chin Med J (Engl). 2008 Jun 5;121(11):1052-4.
Abstract/Text
PMID 18706259
Ren Wang, Lei Chen, Xiaojun Bai, Tingting Li, Dan Wu, Jinjin Chen
Transrectal ultrasound-guided seminal vesicle catheterization with continuous antibiotic infusion for the treatment of refractory hematospermia.
Exp Ther Med. 2021 Jan;21(1):32. doi: 10.3892/etm.2020.9464. Epub 2020 Nov 11.
Abstract/Text 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.

Copyright: © Wang et al.
PMID 33262818
Seiji Furuya, Haruaki Kato
A clinical entity of cystic dilatation of the utricle associated with hemospermia.
J Urol. 2005 Sep;174(3):1039-42. doi: 10.1097/01.ju.0000169494.48968.aa.
Abstract/Text PURPOSE: We investigated the mechanism of hemospermia in patients with a midline cyst (MLC) of the prostate, focusing on cystic dilatation of the utricle (CDU) as a possible causative lesion.
MATERIALS AND METHODS: Of 138 patients with hemospermia 30 (22%) had an MLC, of whom 19 underwent transperineal needle aspiration of the MLC and bilateral seminal vesicles to determine the site of bleeding. Following MLC aspiration a mixture of dye and contrast medium was injected. The verumontanum was observed endoscopically and pelvic x-ray was done.
RESULTS: Seminal vesicle fluid on 1 or 2 sides was hemorrhagic in 13 of the 19 patients (aspiration failed in 6) and fluid from the MLC was nonhemorrhagic in 5 of the 19 (aspiration failed in 7). The MLC communicated with the urethra (CDU) in 15 patients (79%) and with 1 or 2 ejaculatory ducts in 11 (58%). In 5 of 11 patients with communication with the ejaculatory duct hemospermia persisted for more than 1 year. Four of these patients were cured by transurethral unroofing of the CDU.
CONCLUSIONS: CDU is a significant underlying lesion for hemospermia. Communication with the ejaculatory ducts was frequent in patients with chronic hemospermia and transurethral unroofing was effective for eliminating hemospermia.

PMID 16094043
Hu Han, Xiao-Guang Zhou, Dong-Dong Fan, Long Tian, Xiao-Dong Zhang
An Unusual Etiology for Hematospermia and Treatments That Were Successful.
Urology. 2015 Oct;86(4):740-3. doi: 10.1016/j.urology.2015.06.031. Epub 2015 Jul 16.
Abstract/Text OBJECTIVE: To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma.
METHODS: The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration.
RESULTS: The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available.
CONCLUSION: The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.

Copyright © 2015 Elsevier Inc. All rights reserved.
PMID 26190083
Lei Wang, Zhi-Yong Liu, Chuan-Liang Xu, Ying-Hao Sun, Peng Wan, Xia Sheng, Liang Xiao, Shu-Guang Piao, Hua-Mao Ye, Xin Lu
[Transurethral seminal vesiculoscopy for refractory or recurrent hemospermia: clinical analysis of 162 cases].
Zhonghua Nan Ke Xue. 2013 Jun;19(6):531-4.
Abstract/Text OBJECTIVE: To investigate the feasibility and effect of transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory or recurrent hemospermia.
METHODS: We retrospectively analyzed 162 cases of refractory or recurrent hemospermia examined and treated by transurethral seminal vesiculoscopy. The patients ranged in age from 19 to 76 years and had a hemospermia history of 3 months to 11 years, admitted due to poor therapeutic results or recurrence after 4 weeks of antibiotic medication. All the patients underwent serum PSA examination, transrectal ultrasonography, seminal vesicle ultrasonography and pelvis CT or MRI before surgery.
RESULTS: Wine- or magenta-colored colloid and inflammation were found in one or both sides of the seminal vesicle in all the cases. Pathological biopsy revealed chronic inflammatory mucosa of the seminal vesicle in all the patients, and even calculi in the ejaculatory duct or seminal vesicle in 15 cases. Postoperative follow-up averaged 21.7 (12 -29) months. Hemospermia disappeared or was alleviated in 150 (92.64%) of the cases after 1-15 ejaculations, in which 7 experienced recurrence 3 months later. Four cases failed to respond, and 1 developed acute bilateral epididymitis after surgery. No such complications as retrograde ejaculation, urinary incontinence or rectal injury were observed postoperatively.
CONCLUSION: Transurethral seminal vesiculoscopy is a safe, effective and feasible new method for the treatment of refractory or recrudescent hemospermia.

PMID 23862232
Xue-Sheng Wang, Ming Li, Guang-Feng Shao, Wen-Dong Sun, Xiu-Lin Zhang, Zhi-Ying Xiao, Zhen Ma, Ming-Zhen Yuan, Li-Qiang Guo
Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study.
Asian J Androl. 2020 Sep-Oct;22(5):507-512. doi: 10.4103/aja.aja_134_19.
Abstract/Text This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0-97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0-18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

PMID 31898586
K Ganabathi, D Chadwick, R C Feneley, J C Gingell
Haemospermia.
Br J Urol. 1992 Mar;69(3):225-30.
Abstract/Text Haemospermia is a frightening symptom. Many cases are of benign aetiology but 5 to 10% will have underlying malignancy. Many younger patients require only routine clinical examination, urine analysis and reassurance, but patients aged over 40 years, those with persistent haemospermia, or those with associated haematuria require urological investigation. Imaging of the prostate and seminal vesicles with transrectal ultrasound is of particular value in the investigation of these patients.

PMID 1568093
P Maheshkumar, U Otite, S Gordon, D M Berney, V H Nargund
Testicular tumor presenting as hematospermia.
J Urol. 2001 Jan;165(1):188. doi: 10.1097/00005392-200101000-00050.
Abstract/Text
PMID 11125399
Xiao-Cheng Wu, Vivien W Chen, Brooke Steele, Steven Roffers, Judith B Klotz, Catherine N Correa, Susan E Carozza
Cancer incidence in adolescents and young adults in the United States, 1992-1997.
J Adolesc Health. 2003 Jun;32(6):405-15.
Abstract/Text PURPOSE: To examine cancer incidence patterns among adolescents and young adults in the United States.
METHODS: Cancer incidence data from 26 population-based central cancer registries for 1992-1997 were used. Individual cancers were grouped into specific diagnostic groups and subgroups using an integrated classification scheme. The integrated scheme was developed for this study and was based on the most commonly used schemes in population-based epidemiologic studies: Surveillance, Epidemiology, and End Results Program's site groups, International Classification of Childhood Cancer, and International Agency for Research on Cancer's Histological Groups for Comparative Studies. Percent distributions and age-specific incidence rates per million population were computed for adolescents (aged 15-19 years) and young adults (aged 20-24 years) by gender.
RESULTS: The data for 26,010 cancer cases were examined. Among 15-19-year-olds, the five most common cancers were Hodgkin's disease, leukemia, cancer in the brain and other nervous system, bone cancer, and non-Hodgkin's disease. Among 20-24-year-olds, the five most common cancers were Hodgkin's disease, testicular cancer, thyroid cancer, melanoma of the skin, and leukemia. The proportions and rates of the histologic subtypes for most of the common cancers changed with advancing age. For example, among 15-19-year-olds, acute lymphocytic leukemia accounted for approximately 60% of leukemias in males and 50% in females. Among 20-24-year-olds, however, the corresponding percentages of acute lymphocytic leukemia were 37% in males and 31% in females. For ovarian cancer, the germ cell tumor was the most common subtype (54.6% of all ovarian cancers) among 15-19-year-olds. In contrast, ovarian carcinoma was the predominant subtype (70.4%) among 20-24-year-olds. For both age groups, the incidence rates of nodular Hodgkin's disease, melanoma of the skin, and thyroid cancer were significantly greater in females than in males.
CONCLUSIONS: Cancer incidence patterns among adolescents and young adults are distinctive. In these age groups, a transition from predominantly pediatric histologic subtypes to adult subtypes was observed for Hodgkin's disease, leukemia, ovarian cancer, and soft tissue sarcoma. Gender differences were found for Hodgkin's disease, melanoma of the skin, and thyroid cancer.

PMID 12782451
Dean E Leocádio, Barry S Stein
Hematospermia: etiological and management considerations.
Int Urol Nephrol. 2009;41(1):77-83. doi: 10.1007/s11255-008-9409-9. Epub 2008 Jun 19.
Abstract/Text BACKGROUND: Hematospermia, or blood in the ejaculate, usually follows a benign self-limiting course. However, it can be a source of considerable anxiety in patients. The purpose of this article is to provide the primary care physician an algorithm for the evaluation and management of hematospermia based on frequency of occurrence and patient age.
METHODS: We performed an English language MEDLINE (1966 to present) search for the terms hematospermia, hemospermia, management, prostate biopsy and combinations thereof. We then constructed a management algorithm based on available evidence.
RESULTS: Typically, patients present to their primary care physician after a single episode of hematospermia out of concern for malignancy or venereal disease. In men 40 years old or younger, it is most often due to inflammatory or infectious processes. In men over 40 years of age, however, an association exists between hematospermia and more serious underlying pathology. A significant number of cases remain idiopathic even after extensive investigation.
CONCLUSIONS: Hematospermia is an anxiety-provoking sign that is usually due to inflammatory or infectious causes. Recurrent or symptomatic hematospermia may herald more serious underlying pathology, especially in those patients over 40 years old. A thorough evaluation is warranted to both rule out more serious pathology and to adequately address patient anxiety. With modern imaging techniques, the number of "idiopathic" cases should be much lower than historically reported.

PMID 18563615

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