RESUMO
This study was performed to assess the efficacy of transrectal ultrasonography [TRUS] in the evaluation of patients with hemospermia. A total of 40 patients presenting with hemospermia were evaluated. A good patient history that concentrates on trauma, infections, and bleeding disorders was taken. All patients in our study have more than one episode occurring over weeks to months. A complete physical examination including measuring the patient's blood pressure, examination of the penis, palpation of both vasa and digital rectal examination [DRE] with special attention to the seminal vesicles and the presence of any midline masses, specific attention also given to the prostate. All patients underwent laboratory investigations, including urinalysis and culture, if the history suggests exposure to tuberculosis; urine culture for acid-fast bacilli was done. In younger men, urethral swabs were obtained and examined to exclude non-specific and gonococcal urethritis. Semen analysis and culture was requested for all patients. Prostate-specific antigen [PSA] was done for all patients older than 50 years, and men older than 40 years with a history of prostate cancer in their family. Coagulation studies were done for all patients in our study with persistent hemospermia [more than 2 months] because this condition is associated with coagulopathies. All patients were examined by transrectal ultrasonography using the Bruel and Kjaer model 3535 scanner with the 8551 multiplane probe. Most of our patients are young [mean age less than 40 years] and have symptoms ranging in duration from 1-24 months. TRUS found abnormalities in 95% of patients [38 from 40 patients], which included dilated seminal vesicles [30%], seminal vesicles cysts [15%], ejaculatory duct calculi [10%], asymmetry of the seminal vesicles [10%], prostatic calculi [15%] and hypoechoic suspicious areas in the peripheral zone of the prostate in 6 patients [15%], 2 of them [5%] proved to be cancer prostate after TRUS- guided biopsy. The advent of TRUS has provided physicians with the single most important tool for evaluating patients with hemospermia. TRUS allow clear visualization of the seminal vesicles, prostate and ampullary portions of the vas. As a result, etiologic factors can now be identified more frequently