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Introduction: Haemospermia is an alarming symptom for ordinary members of the public. The worry become greater as it has been described as a warning sign of a prostate cancer in the media. Objectives: The aim of the study was to identify the aetiological factors and outcome of haemospermia in a cohort of patients. Methods: All patients with newly diagnosed haemospermia treated at the urology unit of Colombo South Teaching Hospital over a period of 5 years (2013-2018) constituted the study sample. Data related to demographics, symptomatology, clinical findings, investigations, treatment given and outcome during follow-up were recorded prospectively. Results: There were 94 men with haemospermia who sought treatment during the study period. Mean age was 43.7 years (range: 23-67, median = 41). Twenty-seven (29%) patients had clinical evidence of prostatitis and/or a positive seminal fluid culture. One patient each had prostate carcinoma, prostatic cyst, severe hypertension, sclerotherapy for haemorrhoids, post-chemotherapy and post-epididymectomy. The patient who had high blood pressure (220/150 mmHg) was found to have mesangio-proliferative glomerulonephritis. In 61 (65%) patients, there was no identifiable cause. Conclusion: The majority of patients with haemospermia are aged < 45 years and have a benign aetiology. As haemospermia is self-limiting in the majority of cases, extensive investigations are unnecessary. Advanced and invasive tests should be confined to those with abnormal clinical findings, and to those with persistent or recurrent haemospermia.

Follicular cystitis is a non-specific inflammatory condition of the bladder where the aetiology is unknown. The extent of the disease can be mild or proliferative and bulky. Antibiotics, steroids, therapies used for interstitial cystitis, palliative cystectomy and radiotherapy have been reported as successful treatment options. We report a case of follicular cystitis that responded to a course of oral diethyl carbamazine.

IntroductionColovesical fistulae (CVF) are the relatively uncommon presentation in colorectal surgical practice. However, the rarity of the disease gives rise to problems in diagnosis and treatment as adequately powered data is lacking in published literature. Furthermore, the aetiology of CVF in Asia differs from the West which plays an important role in patient management. MethodsThe records of all the patients with CVF managed in the Gastrointestinal and Urological surgical units of a tertiary care centre over a nine-year period were collected and analysed. Follow-up data have been collected prospectively to assess the outcome. ResultsA total of 11 patients (M: F=9:2) with a median age of 59 years were studied. Faecaluria, pneumaturia and recurrent urinary tract infections were the commonest presenting symptoms. The diagnosis was based on clinical evaluation. Cystoscopy, colonoscopy and CECT were utilized to identify the underlying pathology, complications and for staging. Commonest benign pathology was diverticular disease (n=7), followed by tuberculosis (n=1). Adenocarcinoma of the sigmoid colon and squamous cell Carcinoma of the bladder were reported in three patients. Majority of patients (n=9) were managed successfully by open-left colonic resection with or without temporary ileostomy and bladder repair, while inoperable patients were managed with a stoma. ConclusionCVF is a relatively uncommon condition in our setup and mostly related to isolated diverticular disease of the sigmoid colon. Diagnosis of CVF can be made with accuracy by proper clinical assessment. Cystoscopy and LGIE are essential components of the diagnostic workup of a patient with suspected CVF. During surgery, segmental resection of the colon is favoured than local repair.

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