Recurrent haematospermia: an unusual presentation of autosomal dominant polycystic kidney disease.

Haematospermia, even though alarming, is usually benign and self-limiting, especially in a sexually active male. Nevertheless recurrent, refractory or painful haematospermia is troublesome and warrants thorough evaluation. In this context, we describe a rare case of recurrent haematospermia whereby evaluation revealed haemorrhage in seminal vesicle cysts and consequently established the aetiology of autosomal dominant polycystic kidney disease.

The effect of two levels of hemospermia on stallion fertility.

Hemospermia can occur consistently or intermittently in stallion ejaculates and may cause a reduction in the fertility of the affected ejaculate. It is unknown what amount of blood in an ejaculate leads to subfertility. This study investigated the effect of higher and lower levels of hemospermia (50% and 5%, respectively) on fertility using 24 reproductively normal mares inseminated over three consecutive estrous cycles with fresh extended semen. Mares inseminated with a 5% blood-contaminated ejaculate became pregnant at the same rate (75% per cycle; 18 of 24) as the mares inseminated with blood-free (control) semen (75% per cycle; 18 of 24). The ejaculates containing 50% blood were sterile (0% per cycle, 0 of 24). We concluded that it is the amount of blood, not the mere presence of blood, in an ejaculate that impacts fertility.

Hematospermia: a propósito de un caso / Haemospermia: presentation of a case

La hematospermia o hemospermia es un síntoma muy inquietante en la población masculina, pero que puede ser manejado en muchos casos por los profesionales de atención primaria. Porque no es una demanda habitual en consulta, requiere de conocimiento epidemiológico y un juicio clínico adecuado para poder enfocar correctamente cada caso y transmitir seguridad a nuestros pacientes. La anamnesis es la parte más importante de nuestra intervención, porque respondiendo a 3 cuestiones como la edad, la duración del sangrado y la aparición de síntomas o factores de riesgo asociados, podremos orientar el caso. Es en el diagnóstico donde más se ha avanzado en los últimos años, llegando a conocer la causa de la hematospermia en la mayoría de los casos (AU)

Haematospermia or haemospermia is a worrying symptom in the male population, but can be managed in many cases by primary care providers. As it is not often seen in clinics, it requires epidemiological knowledge and an appropriate clinical judgement to focus correctly on each case and to ensure the safety of our patients. The clinical history is the most important part of our intervention, and answering three questions, such as age, duration of bleeding and symptoms or risk factors may help in the diagnosis. More progress has been made in its diagnosis in recent years, due to determining the cause of the haematospermia in most cases (AU)

Well-differentiated papillary mesothelioma of the epididymis in a man with recurrent haematospermia.

We present a case of well-differentiated papillary mesothelioma of the epididymis occurring in a 60-year-old man who came to urologic consult after recurrent episodes of haematospermia. The patient denied pain, fever and trauma in genitals. Local examination revealed indolent swelling at the right testicle and ecography localised a well-circumscribed nodule at the epididymis tail, measuring 2 cm in greater diameter, with associated haemorrhagic hydrocele. A nodulectomy was performed and the patient is alive with no evidence of disease 17 months following surgery.

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.

Hematospermia: diagnosis and treatment.

The presence of blood in ejaculate represents 1% of all andrologic and urologic symptoms. In most cases it has a benign character and tends to regress spontaneously after the first episode. But in the same case it can be caused by bladder-prostate or systemic malignant patology, so it is necessary to subject the patient to laboratory and instrumental tests in order to find the best treatment that, as for hematospermia, is an etiological one. Most important for correct diagnosis are patient history, physical examination, laboratory tests, transrectal ultrasound examination of the prostate, MRI, CT, cistoscopy. Hematospermia is rarely associated with significant pathology, especially in younger men. The 3 factors that dictate the extent of the evaluation and treatment are patients age, the duration and recurrence of the hematospermia, and the presence of any associated hematuria. So it is possible to distinguish idiopathic from secondary hematospermia, because secondary hematospermia, i.e. the one in which the bleeding cause is known or suspected, requires an etiologic treatment. Urologists must make rational decisions based on evidence rather than practice defensive medicine. Understanding the pathophysiology and prevalence in populations of different ages helps minimize the likelihood of problems. When in doubt, performing a TRUS, cystoscopy, and basic laboratory analyses limits exposure.

Association of hemospermia with prostate cancer.

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.