ABSTRACT
Background: Hematospermia, although often found to be a benign condition, can be an alarming sign. Consequently, patients can undergo multiple investigations with no current standardized pathway based on data from large series. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia. Materials and methods: A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center. Patient demographics, radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes. Results: In this cohort, the overall prostate cancer detection rate was 5.3% and 7.2% in the ≥40 years group. One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy. In addition, 5.6% of patients were found to have a significant benign pathology for which intervention was proposed. A total of 288 patients underwent a transrectal ultrasound scan and 58.7% (n = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% (n = 81) had a positive finding. Conclusions: Apart from transrectal ultrasound and multiparametric magnetic resonance imaging, the remaining investigations have a low diagnostic yield. Prostate cancer detection was 5.3%; 7.2% in the ≥40 years group, and two further patients were diagnosed with testicular and bladder malignancy. Based on our results, we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.
ABSTRACT
Background: Urethral catheterization is a common procedure, with a low complication rate. Aberrant catheterization into a ureter is a rare complication. We present a case of an aberrant urethral catheterization into the right ureter in a postpartum female. Case Presentation: An 18-year-old primigravida female presented with loin pain and catheter bypassing after a postpartum urethral catheterization. Examination under anesthesia and cystoscopy revealed the catheter leading into the right ureter, which was confirmed by subsequent CT urogram. Multiple attempts to remove the catheter failed. A rigid ureteroscopy was performed, revealing "kinking" of the catheter just distal to the balloon, as a result of an asymmetrical inflated balloon. A laser fiber inserted through the ureteroscope punctured the balloon, allowing balloon deflation and catheter removal under screening. A relook ureteroscopy 8 weeks later confirmed a healed ureter. Conclusion: Asymmetric catheter balloon inflation causes kinking of a catheter and occlusion of the balloon port that will prohibit balloon deflation. During rigid ureteroscopy, a laser fiber can be used to puncture the catheter balloon, allowing balloon deflation and catheter removal.
