Hematospermia: An investigation of the bleeding site and underlying lesions

Abstract

Background: The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance. Methods: Twenty-one patients aged 26-75 years (mean, 49.8 years) underwent transperineal needle aspiration of the seminal vesicles and/or müllerian duct cysts guided by transrectal ultrasonography (TRUS).Results: Dark reddish seminal vesicle fluid was aspirated and the site of bleeding was considered to be the seminal vesicles in 11 patients (52%) (group A). In group A, abnormalities of the seminal vesicles were noted in nine patients (82%). These consisted of dilated seminal vesicles in seven (bilateral in four, unilateral in three), a seminal vesicle cyst in one and seminal vesicle amyloidosis in one. A müllerian duct cyst was confirmed to be the bleeding site in two patients (10%; group B). The bleeding site was estimated to be organs rather than the seminal vesicles in four patients (group C), in all of whom ectopic prostatic tissue was observed in the prostatic urethra. In groups B and C, seminal vesicle abnormalities were not detected by TRUS. In the remaining four patients (group D), failure to aspirate seminal vesicle fluid means that it is unclear whether hemorrhage was from the seminal vesicle or from another source. In group D, ectopic prostatic tissue was demonstrated in the prostatic urethra of three patients and unilateral seminal vesicle dilation was detected by TRUS in one patient. Conclusion: Puncture of the seminal vesicles and/or müllerian duct cysts under ultrasonic guidance as well as cystourethroscopy is a useful and minimally invasive examination for determination of the bleeding site responsible for hematospermia.

Hemospermia in Patients with Congenital Coagulation Disorders: A Study of Three Cases

“…Old age, the concomitant presence of hematuria and overt or covert prostate neoplasia are negative prognostic factors and need an extensive investigation [1,2,3]. None of these conditions were present in our patients, and this probably explains the relatively benign outcomes.…”

“…The main causes of hemospermia are shown in table 1. The sources of bleeding in hemospermia are diverse and include the epididymis, vas deferens, seminal vesicle, verumontanum, prostate gland, urethra, prostatic utricle, ectopic prostatic tissue in urethra and Müllerian duct cyst [2, 3]. The most complete list of referenced causes of hemospermia has been supplied recently by Torigian and Ramchandani [10].…”

“…In the presence of an aged patient with a coagulation disorder presenting repeated bouts of hemospermia, it is advisable that an extensive investigation (cystoscopy, sonography, CAT, MRI) be carried out [3, 6, 10]. …”

“…Because of the increase in life expectancy in the general population and also, to a smaller degree, in patients with congenital coagulation disorders, it is likely that the symptom might receive greater attention in the future. Prostate cancer incidence increases with age and it is a relatively common source of hemospermia [3,4,5,6]. …”

“…Hemospermia, or hematospermia, is clinically significant for at least 3 reasons [1,2,3,4,5]. First, it may be an important sign of an underlying urological condition.…”