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1.
BMC Surg ; 23(1): 385, 2023 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-38129847

RESUMO

PURPOSE: To explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome. MATERIALS AND METHODS: A retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy. RESULTS: The total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010). CONCLUSIONS: The Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.


Assuntos
Cálculos , Cistos , Hemospermia , Masculino , Humanos , Glândulas Seminais/cirurgia , Hemospermia/etiologia , Hemospermia/cirurgia , Estudos Retrospectivos , Ductos Ejaculatórios/cirurgia
2.
Zhonghua Nan Ke Xue ; 29(1): 49-53, 2023 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-37846832

RESUMO

OBJECTIVE: To summarize the clinical experience in the treatment of sexual intercourse-related hematuria in males using biopsy forceps, electrocoagulation and holmium laser cauterization. METHODS: From July 2018 to April 2022, we treated 11 male patients with intercourse-related hematuria using biopsy forceps, electrocoagulation and holmium laser cauterization. The patients ranged in age from 29 to 47 years, with clinical manifestations of gross hematuria, blood dripping from the urethral orifice or blood clots in the urine after sexual intercourse or erection, 3 with hemospermia, but none with pain. All the patients received urological imaging examination to exclude lesions in the upper urinary tract and bladder preoperatively. During the operation, varicose vessels were found around the posterior urethral verumontanum under the cystourethroscope in all the cases, 5 with active bleeding in the posterior varicose vessel. The 3 cases with hemospermia first underwent trans-prostatic utricle seminal vesiculoscopy. According to the range and number of varicose vessels, 5 of the patients were treated by electrocoagulation with the resectoscope, 2 by holmium laser cauterization and the other 4 with biopsy forceps to destroy the vascular tissue. After the operation, urinary catheters were retained for 3-7 days, abstinence lasted 30 days, and the patients were followed up for 6 months. RESULTS: The operations were successfully completed in all the cases, 10 with good prognosis and none with recurrence. Occasional postoperative hematuria and blood clots in the urine were observed in 1 of the patients treated by electrocoagulation under the resectoscope, with dysuria at 3 months after operation, who underwent repeated electrocoagulation and experienced no more recurrence thereafter. Different degrees of postoperative urethral irritation and gross hematuria were found in all the cases, which spontaneously disappeared within 1-4 weeks, with no such complications as ED, ejaculation pain, ejaculation difficulty and ejaculation weakness. CONCLUSION: In the absence of other genitourinary diseases, painless hematuria, blood clots in the urine or even dysuria in males after sexual intercourse can be considered as the results of possible varicose veins around the posterior urethral verumontanum, which can be treated satisfactorily by destroying the vascular tissue with biopsy forceps, electrocoagulation with the resectoscope or holmium laser cauterization according to the location, number and degree of varicose veins.


Assuntos
Hemospermia , Trombose , Varizes , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Hemospermia/etiologia , Coito , Hematúria/etiologia , Disuria/complicações , Varizes/complicações , Trombose/complicações , Dor
4.
Georgian Med News ; (335): 69-72, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37042592

RESUMO

Haematospermia is the medical term used to describe the presence of blood in semen. It can occur due to a variety of reasons and can be a benign or serious condition. The present study aimed to identify the prevalence and characterization of haematospermia in patients visiting hospital clinics. To do so, a total of 44 patients were recruited and characterized regarding their demographic variation, symptoms, severity, associated diseases, and measured prostate-specific-antigen (PSA). Results confirmed that patients were middle-aged (around 40 years) and the duration (days) of haematospermia is around 16±12. Only a few of these patients have shown an association with chronic diseases such as hypertension and diabetes or other vascular diseases. Less than 50% of these patients have shown past-surgical history and few of them were using anticoagulants 16±12. The majority of patients had painless haematospermia while only (13.6%) had painful haematospermia, irritative urinary symptoms were found in (13.6%) while obstructive urinary symptoms in (4.5%). Ultrasound (US) examination of the abdomen, pelvis, and scrotum was normal in more than 50% of them while others have shown prostatic involvement. Few of these patients experienced pus on laboratory examination. To sum up, haematospermia is represented as an inconvenient disease in our sample leading to interference with daily quality of life, with no clear understanding aetiology of the disease and its progression.


Assuntos
Hemospermia , Masculino , Pessoa de Meia-Idade , Humanos , Hemospermia/diagnóstico , Hemospermia/etiologia , Iraque , Qualidade de Vida , Próstata , Análise do Sêmen
5.
Urology ; 171: 146-151, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36241064

RESUMO

OBJECTIVE: To (i) identify a novel risk stratification for patients complaining of haemospermia; and, (ii) compare its predictive ability to select high-risk patients by retrospectively validating the EAU guidelines classification. METHODS: Data from 283 consecutive patients complaining of a single episode/recurrent haemospermia were retrospectively analyzed. Patients were stratified into low vs high-risk according to EAU guidelines, whose diagnostic performance was then validated. We identified a new risk stratification model based on clinical factors associated with (i) positive semen culture and (ii) prostate cancer (PCa) and bladder cancer (BC). Diagnostic accuracy of the two predictive models (EAU vs New) was assessed and decision curve analyses (DCA) tested their clinical benefit. RESULTS: Overall, 259 (91.5%) were high-risk and 24 (8.5%) low risk according to the EAU guidelines. Recurrent haemospermia was reported by 134 (47.4%) patients. 126 (44.5%) had baseline CCI score ≥ 1. At MVA logistic regression analysis, history of recurrent genito - urinary tract infections was identified as a predictor for positive semen culture (OR: 3.39, 95% CI: 1.77 - 6.57, P =.002). Likewise, baseline CCI ≥ 1 was identified as a predictor for PCa and BC (OR: 1.55, 95% CI: 1.17 - 2.04, P =.009). Sensitivity, specificity, and AUC of the EAU guidelines were 13.3%, 89.2% and 51% respectively, whereas the new model performed substantially better: 98.9%, 58% and 78% respectively. CONCLUSION: The application of the EAU guidelines risk stratification does not ensure proper identification of high-risk patients complaining of haemospermia. We propose a novel, better performing and easily implementable risk stratification tool.


Assuntos
Hemospermia , Neoplasias da Próstata , Masculino , Humanos , Estudos Retrospectivos , Hemospermia/diagnóstico , Hemospermia/epidemiologia , Hemospermia/etiologia , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico , Sêmen , Medição de Risco
7.
BMC Urol ; 22(1): 187, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384575

RESUMO

BACKGROUND: Most patients with splenosis have no clinical symptoms and do not need intervention. Hematospermia and testicular pain occurred in this patient, which was considered to be related to the huge pelvic implantation of the spleen, which was relatively rare in clinical practice, so we hereby report this case. CASE PRESENTATION: A 28-year-old male patient with a history of splenectomy was admitted to the Urology Department of the Second Affiliated Hospital of Anhui Medical University with the chief complaint of "Hematospermia for 1 month and testicular pain for 2 days". Preoperative imaging examination indicated pelvic mass. Combined with the patient's history of splenectomy for splenic rupture in childhood, the possibility of pelvic spleen implantation was considered. Laparoscopic pelvic exploration was performed. During the operation, multiple grayish-brown nodular tissues were observed in the space between the posterior bladder and rectum, and a lobulated grayish-brown mass with a diameter of about 9 cm was observed in the posterior upper part of the prostate gland and seminal vesicle at the pelvic floor. Two nodular tissues were removed intraoperatively and sent for quick frozen pathology, which was reported as spleen tissue. Further resection of the huge mass was performed, and the postoperative pathological results were consistent with the diagnosis of splenosis. CONCLUSION: We report a rare case of splenosis presenting with hemospermia and testicular pain.


Assuntos
Hemospermia , Esplenose , Masculino , Humanos , Adulto , Esplenose/complicações , Esplenose/diagnóstico , Esplenose/cirurgia , Hemospermia/diagnóstico , Hemospermia/etiologia , Esplenectomia/métodos , Dor
8.
PLoS One ; 17(7): e0268314, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35789209

RESUMO

We have summarized our experience regarding transurethral seminal vesiculoscopy (TUSV) and analyzed both its recurrence status and the risk factors for recurrence. From January 2010 to December 2020, 48 patients with intractable hemospermia received successful TUSV at Taichung Invalids General Hospital. Upon analysis of the intraoperative findings, the five-year disease-free Survival rates (DFS) were 74.1% in the no calculus group compared to 37.1% in the calculus group with a significant difference (log-rank p = 0.015), 75.0% in the no hemorrhage or no blood clot group compared to 43.2% in the hemorrhage or blood clot group with significant difference (log-rank p = 0.032). Univariate analysis showed intraoperative calculus (p = 0.040; HR: 2.94, 95% CI: 1.05-8.21) to be significantly associated with recurrence (p < 0.05). Patients with intractable hemospermia who were diagnosed with stones or blood clots found during TUSV experienced a higher rate of hemospermia recurrence.


Assuntos
Cálculos , Hemospermia , Hemorragia , Hemospermia/diagnóstico , Hemospermia/etiologia , Hemospermia/cirurgia , Humanos , Masculino , Fatores de Risco , Glândulas Seminais/cirurgia
9.
Andrology ; 10(5): 919-925, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35483126

RESUMO

BACKGROUND: Hematospermia is an alarming symptom and can cause significant patient distress, but work-up is often negative. OBJECTIVE: To characterize the clinical evaluation of hematospermia and its association with the diagnosis of urologic malignancy. MATERIALS AND METHODS: Using MarketScan insurance claims database, we identified adult males 18-64 years old diagnosed with hematospermia from 2010 to 2018. Benign hematospermia was defined as the absence of hematuria and elevated prostate-specific antigen. Patients with urologic cancer prior to diagnosis of hematospermia were excluded. We identified those who were diagnosed with a urologic malignancy. RESULTS: The annual average incidence rate of hematospermia was 56.6 per 100,000 (95% confidence interval 55.4-57.8 per 100,000) in 2010 and increased to 73.6 per 100,000 (95% confidence interval 71.7-75.4 per 100,000) in 2018. A total of 56,157 patients presented with benign hematospermia. Most (57.5%) underwent at least one test, with the most common being urinalysis (51.7%), followed by prostate-specific antigen testing (11.9%). All other tests were performed in less than 3% of patients. Forty-seven patients were diagnosed with a urologic cancer, including 28 with prostate cancer (0.05%), nine with testicular cancer (0.016%), six with prostate carcinoma in situ (0.01%), and four with bladder cancer (0.007%). Stratified by age, there was only one cancer diagnosis (testicular) in 15,106 patients under 40 years (0.01%) and 46 cancer diagnoses in 40,611 patients 40 years old or above (0.11%). The median age of patients diagnosed with cancer was 56 years (interquartile range 52-61). DISCUSSION AND CONCLUSION: A small minority of patients with benign hematospermia were later diagnosed with urologic cancer in a large nationally representative sample. After excluding hematuria with urinalysis, physicians should conservatively manage and reassure patients with hematospermia, especially those under 40 years of age.


Assuntos
Hemospermia , Neoplasias da Próstata , Neoplasias Testiculares , Neoplasias Urológicas , Adolescente , Adulto , Hematúria/complicações , Hematúria/epidemiologia , Hemospermia/diagnóstico , Hemospermia/epidemiologia , Hemospermia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico , Neoplasias da Próstata/complicações , Neoplasias da Próstata/epidemiologia , Neoplasias Testiculares/complicações , Estados Unidos/epidemiologia , Adulto Jovem
10.
Acta Biomed ; 93(S1): e2022094, 2022 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-35420599

RESUMO

BACKGROUND AND AIM: Prostatic utricle cyst is an embryological remnant of the Muller duct system, resulting from an incomplete regression of these structures during embryological development. Most of the time such congenital alteration is asymptomatic, but may sometimes present with various signs and symptoms, from urinary tract infections to episodes of haematospermia in a small percentage of cases. METHODS: We reported the case of a 42-years-old man who suffered from recurrent episodes of haematospermia for about 20 years; the instrumental examinations, first of all TRUS and then MRI evaluation, demonstrated the presence of a cystic formation, located in the posterior median site of the prostate closely to the prostatic urethra. RESULTS: The cytological examination on the liquid taken by transperineal US-guided fine-needle aspiration, confirmed the presence of seminal fluid and normal prostatic tissue consistent with the diagnostic hypothesis of prostatic utricle cyst. CONCLUSIONS: It's important to recognize the imaging characteristics of the prostatic utricle cyst since it may be one of the possible benign causes of hematospermia in the young adult subject.


Assuntos
Cistos , Hemospermia , Lesões Pré-Cancerosas , Adulto , Cistos/complicações , Cistos/diagnóstico por imagem , Hemospermia/etiologia , Humanos , Masculino , Próstata/anormalidades , Próstata/diagnóstico por imagem , Sáculo e Utrículo , Uretra , Adulto Jovem
11.
Zhonghua Nan Ke Xue ; 28(11): 1011-1014, 2022 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-37846117

RESUMO

OBJECTIVE: To investigate the clinical effect and safety of transutricular seminal vesiculoscopy in the treatment of refractory hemospermia. METHODS: Using 6Fr ureteroscopy through the prostatic utricle, we treated 103 cases of refractory hemospermia with distal seminal duct obstructive lesions, including 12 cases complicated by distal seminal duct cyst. We rinsed the seminal duct cavity, cleaned out the stones, removed the cyst wall with holmium laser and followed up the patients for 12 months postoperatively. RESULTS: The operations were successfully completed in all the cases but 1 (0.9%), in which the ureteroscope failed to enter the bilateral seminal vesicles. The operation time was (47 ± 9) min. No rectal injury or acute epididymitis occurred intraoperatively, nor fever, long-term dysuria or long-term hematuria after surgery. Postoperative follow-up showed that bloody semen symptoms vanished in 93 (90.3%) of the cases, improved significantly in 4 (3.9%) and not significantly in 2 (1.9%), and 3 cases of recurrence (2.9%) were all relieved after reoperation. CONCLUSION: Transutricular seminal vesiculoscopy has the advantages of clear anatomic vision, minor invasiveness and significant effectiveness in the treatment of refractory hemospermia. What's more, holmium laser is better than plasmakinetic resection in removal of the cyst wall.


Assuntos
Cistos , Hemospermia , Masculino , Humanos , Hemospermia/etiologia , Glândulas Seminais/cirurgia , Ureteroscopia/efeitos adversos , Próstata , Ductos Ejaculatórios
12.
Sex Med Rev ; 10(4): 669-680, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-34538619

RESUMO

INTRODUCTION: Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare condition that is historically idiopathic or associated with sexual behavior. Technological advances have identified many of the etiologies behind HS, improving treatment. Though often benign, HS remains a source of considerable sexual anxiety for patients. Few papers have outlined a diagnostic and therapeutic approach to HS, and none have explicitly addressed its sexual consequences. OBJECTIVES: To provide a comprehensive overview of HS, emphasizing its sexual ramifications. METHODS: A PubMed literature search was performed through May 2021 to identify all relevant publications related to etiology, diagnosis, treatment, and sexual effects of HS. Original research and reviews were analyzed, and pertinent studies were included in this review. RESULTS: Iatrogenic interventions (eg, transrectal ultrasound-guided prostate biopsies) are the most common cause of HS. Infection and/or nonspecific inflammation is the most common non-iatrogenic etiology. Malignancies, including prostate, testicular, and other genitourinary cancers, are rarely the cause of HS. Diagnostic approaches to HS can be organized according to patient age (less than or greater than 40 years old), persistence of bleeding, and the presence/absence of concerning symptoms. Though HS often spontaneously resolves, treatment may require various medications (eg, antibiotics, anti-inflammatories) or surgical interventions. HS has several sexual ramifications, including libido-affecting anxiety, social repercussions from sexual partners and non-sexual affiliates, increased risk of erectile dysfunction or transmission of sexual infections, and compromised fertility, especially when cryopreservation is utilized. CONCLUSION: HS may significantly affect sexual health through several mechanisms, though there is a paucity of formal data on this subject. Further research is needed to fully understand the severity and extent of HS's effect on sexual well-being, especially in those with refractory bleeding. Drury RH, King B, Herzog B, et al. Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A Narrative Review. Sex Med Rev. 2022;10:669-680.


Assuntos
Disfunção Erétil , Hemospermia , Adulto , Antibacterianos , Disfunção Erétil/complicações , Hemospermia/diagnóstico , Hemospermia/etiologia , Hemospermia/terapia , Humanos , Masculino , Próstata , Comportamento Sexual
13.
Sex Med Rev ; 10(4): 669-680, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37051970

RESUMO

INTRODUCTION: Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare condition that is historically idiopathic or associated with sexual behavior. Technological advances have identified many of the etiologies behind HS, improving treatment. Though often benign, HS remains a source of considerable sexual anxiety for patients. Few papers have outlined a diagnostic and therapeutic approach to HS, and none have explicitly addressed its sexual consequences. OBJECTIVES: To provide a comprehensive overview of HS, emphasizing its sexual ramifications. METHODS: A PubMed literature search was performed through May 2021 to identify all relevant publications related to etiology, diagnosis, treatment, and sexual effects of HS. Original research and reviews were analyzed, and pertinent studies were included in this review. RESULTS: Iatrogenic interventions (eg, transrectal ultrasound-guided prostate biopsies) are the most common cause of HS. Infection and/or nonspecific inflammation is the most common non-iatrogenic etiology. Malignancies, including prostate, testicular, and other genitourinary cancers, are rarely the cause of HS. Diagnostic approaches to HS can be organized according to patient age (less than or greater than 40 years old), persistence of bleeding, and the presence/absence of concerning symptoms. Though HS often spontaneously resolves, treatment may require various medications (eg, antibiotics, anti-inflammatories) or surgical interventions. HS has several sexual ramifications, including libido-affecting anxiety, social repercussions from sexual partners and non-sexual affiliates, increased risk of erectile dysfunction or transmission of sexual infections, and compromised fertility, especially when cryopreservation is utilized. CONCLUSION: HS may significantly affect sexual health through several mechanisms, though there is a paucity of formal data on this subject. Further research is needed to fully understand the severity and extent of HS's effect on sexual well-being, especially in those with refractory bleeding.


Assuntos
Disfunção Erétil , Hemospermia , Masculino , Humanos , Adulto , Hemospermia/diagnóstico , Hemospermia/etiologia , Hemospermia/terapia , Disfunção Erétil/complicações , Próstata , Comportamento Sexual , Ejaculação
14.
Medicine (Baltimore) ; 100(34): e26985, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449467

RESUMO

BACKGROUND: The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB). METHODS: We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding. RESULTS: Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.09-1.49], P = .002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RR = 1.02, 95%CI [0.91-1.16], P = .71) and hematospermia (RR = 0.93, 95%CI [0.82-1.06], P = .29). CONCLUSION: Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.


Assuntos
Aspirina/efeitos adversos , Biópsia por Agulha/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Aspirina/administração & dosagem , Ensaios Clínicos como Assunto , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/etiologia , Hematúria/induzido quimicamente , Hematúria/etiologia , Hemospermia/induzido quimicamente , Hemospermia/etiologia , Humanos , Masculino , Inibidores da Agregação Plaquetária/administração & dosagem , Próstata/patologia , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção
15.
Eur Urol ; 80(3): 333-357, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34183196

RESUMO

CONTEXT: The present summary of the European Association of Urology (EAU) guidelines is based on the latest guidelines on male sexual health published in March 2021, with a last comprehensive update in January 2021. OBJECTIVE: To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health. EVIDENCE ACQUISITION: A literature review was performed up to January 2021. The guidelines were updated, and a strength rating for each recommendation was included based on either a systematic review of the evidence or a consensus opinion from the expert panel. EVIDENCE SYNTHESIS: Late-onset hypogonadism is a clinical condition in the ageing male combining low levels of circulating testosterone and specific symptoms associated with impaired hormone production and/or action. A comprehensive diagnostic and therapeutic work-up, along with screening recommendations and contraindications, is provided. Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Along with a detailed basic and advanced diagnostic approach, a novel decision-making algorithm for treating ED in order to better tailor therapy to individual patients is provided. The EAU guidelines have adopted the definition of premature ejaculation (PE), which has been developed by the International Society for Sexual Medicine. After the subtype of PE has been defined, patient's expectations should be discussed thoroughly and pharmacotherapy must be considered as the first-line treatment for patients with lifelong PE, whereas treating the underlying cause must be the initial goal for patients with acquired PE. Haemospermia is defined as the appearance of blood in the ejaculate. Several reasons of haemospermia have been acknowledged; the primary goal over the management work-up is to exclude malignant conditions and treat any other underlying cause. CONCLUSIONS: The 2021 guidelines on sexual and reproductive health summarise the most recent findings, and advise in terms of diagnosis and treatment of male hypogonadism and sexual dysfunction for their use in clinical practice. These guidelines reflect the multidisciplinary nature of their management. PATIENT SUMMARY: Updated European Association of Urology guidelines on sexual and reproductive health are presented, addressing the diagnosis and treatment of the most prevalent conditions in men. Patients must be fully informed of all relevant diagnostic and therapeutic options and, together with their treating physicians, decide on optimal personalised management strategies.


Assuntos
Disfunção Erétil , Hemospermia , Hipogonadismo , Ejaculação Precoce , Disfunção Erétil/diagnóstico , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Europa (Continente) , Hemospermia/diagnóstico , Hemospermia/etiologia , Hemospermia/terapia , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/tratamento farmacológico , Hipogonadismo/etiologia , Masculino , Guias de Prática Clínica como Assunto , Ejaculação Precoce/diagnóstico , Ejaculação Precoce/etiologia , Ejaculação Precoce/terapia
16.
Int J Impot Res ; 33(6): 627-633, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32704074

RESUMO

We investigated the prevalence of hematospermia among the 161,258 men with ≥18 years old, presenting to outpatient clinics with urologic complaints, between January 2003 and December 2017. We also recorded underlying causes of hematospermia to determine frequency of genitourinary cancer in 342 men who presented with hematospermia. Further evaluations such as urine/semen culture, Meares-Stamey four glass test, transrectal/scrotal ultrasound, pelvic magnetic resonance imaging (MRI), cystourethroscopy, and prostate biopsy were performed in the presence of additional symptoms and findings or recurrence of hematospermia after treatment of patients with monosymptomatic hematospermia. The prevalence of hematospermia was detected as 0.21% (342/161,258) among the urological patients. The mean age of the patients was 45.05 ± 14.04 years (range 18-85), and the median duration of hematospermia was 15 days (range 1-7200). In 306 (89.5%) of the patients, hematospermia was resolved after medical therapy for infections/inflammations, surgery for ductal obstruction and cysts, prostate and testicular cancer. However, 36 (10.5%) had persistent hematospermia. The most relevant etiologic cause of hematospermia was inflammation/infections in 169 patients (49.4%), and genitourinary cancers were detected in only 11 patients (3.2%) as prostate cancer in 8 and testicular cancer in 3. Hematospermia is seen frequently due to inflammatory or infectious causes, and is rarely associated with genitourinary cancer. However, genitourinary cancers should be kept in mind in the differential diagnosis of patients with recurrent/persistent hematospermia and associated symptoms, such as hematuria, lower urinary tract symptom, and scrotal pain/swelling.


Assuntos
Hemospermia , Neoplasias Testiculares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemospermia/epidemiologia , Hemospermia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Sêmen , Ultrassonografia , Adulto Jovem
17.
BMC Urol ; 20(1): 78, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600309

RESUMO

BACKGROUND: Recurrent hematospermia accompanied by postejaculatory hematuria is a very rare phenomenon, has not been well understood in the clinical setting, and usually leads to misdiagnosis and mistreatment. The aim of this study was to summarize the clinical characteristics, etiologic diagnosis, and endoscopic treatment of hematospermia with postcoital hematuria. METHODS: We collected the clinical data from 39 patients of hematospermia with postcoital hematuria, who were admitted to our hospital from May 2014 to October 2019. The etiologic diagnostic process and endoscopic surgery were analyzed retrospectively, and we observed and evaluated the efficacy and any complications during follow-up. RESULTS: The average age of the 39 patients was 44.1 years (range, 18-61 years), and the disease history ranged from 1 month to 20 years, with a median duration of 24 months. All of the patients were observed by urethrocystoscopy, which showed 38 cases of posterior urethral hemangioma (PUH) or abnormal varicose vessels, and 1 case of anterior urethral hemangioma. Of these, 18 patients underwent transurethral resection of urethral hemangioma, and 21 patients underwent transurethral electrocauterization. Postoperative follow-up ranged from 1 to 56 months, with a median of 16 months. The symptoms disappeared in 37 patients and recurred in 2 patients two to 3 months after the operation. The two recurrent patients were treated again by transurethral electrocauterization, and their symptoms then disappeared. CONCLUSIONS: PUH is the most common cause of hematospermia with postejaculatory hematuria. Herein, we demonstrated that transurethral resection or electrocauterization provides a safe, effective, and minimally invasive method for the treatment of PUH.


Assuntos
Endoscopia , Hemangioma/cirurgia , Hemospermia/diagnóstico , Hemospermia/cirurgia , Neoplasias Uretrais/cirurgia , Adolescente , Adulto , Coito , Hemangioma/complicações , Hematúria/etiologia , Hemospermia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Uretrais/complicações , Adulto Jovem
18.
BMC Urol ; 20(1): 34, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32293392

RESUMO

BACKGROUND: Persistent or recurrent haemospermia often occurs in individuals with ejaculatory duct obstruction (EDO). This study aimed to evaluate the efficacy and safety of transurethral resection of the ejaculatory duct (TURED) combined with seminal vesiculoscopy in treating persistent or recurrent haemospermia in men with EDO. METHODS: From June 2014 to March 2018, 103 consecutive patients with EDO who underwent TURED combined with seminal vesiculoscopy for persistent or recurrent haemospermia at the Department of Urology of West China Hospital were enrolled into this retrospective study. The patients were evaluated mainly by detailed history-taking and performing semen analysis, transrectal ultrasonography, and magnetic resonance imaging. RESULTS: Among the 103 patients, 79 (76.70%) had cysts of the lower male genitourinary tract; 63 (61.17%) had blood clots; and 32 (31.07%) had calculi in the seminal vesicle and/or prostatic utricle. The duration of postoperative follow-up was 12 months, and the symptoms of haemospermia disappeared in 96 (93.20%) patients. There was no significant difference in the semen PH and sperm count before and after surgery; however, the ejaculate volume and sperm motility significantly improved postoperatively. Except for two cases of acute urinary retention and one case of watery ejaculate after surgery, no severe postoperative complications, including epididymitis, urethral stricture, urinary incontinence, retrograde ejaculation, or rectal injury, were observed. CONCLUSION: TURED combined with seminal vesiculoscopy is a suitable method for the diagnosis and treatment of persistent or recurrent haemospermia in men with EDO.


Assuntos
Ductos Ejaculatórios/cirurgia , Doenças dos Genitais Masculinos/cirurgia , Hemospermia/cirurgia , Glândulas Seminais/cirurgia , Adulto , Idoso , Endoscopia , Hemospermia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
19.
Urology ; 140: 122-131, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32061825

RESUMO

OBJECTIVE: To evaluate the feasibility of "in-office" TPFBx under local anesthesia (LA). MATERIALS AND METHODS: We prospectively screened for eligibility data of 724 consecutive men undergoing either TPFBx (target and systematic cores) or TPSBx (systematic cores only) from September 2016 to June 2018 due to suspicion of prostate cancer (CaP), according to predefined exclusion criteria. RESULTS: We included 459 men (TPFBx n = 279 including n = 338 mpMRI lesions, Pi-RADS 4 in 63.6%; TPSBx n = 180). Median procedural time and maximum pain were 19 minutes and 5 numeric rating scale (NRS) points; pain was highest at the time of LA. Only 1 major complication occurred (Clavien 3a). Hematuria and hematospermia were frequent (72.6% and 54.2%). Vaso-vagal reactions and AUR were rare (0.7% and 0.4%). No cases of UTI and 1 case of fever were recorded. No significant changes in erectile and urinary functions were noted from baseline compared to 40 days after TPFBx (P = .86 and P = .89). In comparison with TPSBx the sole differences were pain during prostatic sampling (P = .03), duration of hematospermia (P <.0001) and procedural time (P <.001) all higher for TPFBx. Clinically significant (cs) CaP was detected in n = 150 (53.8%) patients in the TPFBx group (34.9%, 51.7%, and 75% of Pirads 3, 4, and 5, respectively). Addition of systematic cores detected n = 25 csCaP that were missed by targeted cores (17.4% of all csCaP). CONCLUSION: TPFBx under LA are feasible, yielding high tolerability, low complications, no impact on erectile and urinary function and good csCaP detection. Addition of systematic to targeted cores remains recommended. Further studies are needed to confirm our findings.


Assuntos
Hematúria , Hemospermia , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Complicações Pós-Operatórias , Próstata , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção/métodos , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Anestesia Local/métodos , Estudos de Viabilidade , Hematúria/diagnóstico , Hematúria/etiologia , Hemospermia/diagnóstico , Hemospermia/etiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/estatística & dados numéricos , Itália/epidemiologia , Masculino , Imagem Multimodal/métodos , Dor Processual/prevenção & controle , Ereção Peniana , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/epidemiologia , Micção
20.
Asian J Androl ; 22(5): 507-512, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31898586

RESUMO

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.


Assuntos
Endoscopia/métodos , Hemospermia/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cálculos/complicações , Cálculos/cirurgia , Doença Crônica , Cistos/complicações , Cistos/cirurgia , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Seguimentos , Hemospermia/diagnóstico por imagem , Hemospermia/etiologia , Humanos , Inflamação/complicações , Inflamação/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Glândulas Seminais/diagnóstico por imagem , Ultrassonografia de Intervenção/efeitos adversos , Adulto Jovem
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