Laboratory and clinical management of leukocytospermia and hematospermia: a review

Abstract

Leukocytospermia and hematospermia are defined as the presence of abnormally high white blood cell and red blood cell concentration in the semen, respectively. Numerous etiologies and various implications on fertility have been identified. In a small proportion of men, the presence of white blood cells or red blood cells can adversely affect sperm quality by the production of reactive oxygen species. Several methods have been used to assess the presence of white blood cells and red blood cells in samples, such as identification of round cells, immunohistochemical staining using monoclonal antibodies, the Endtz test, the peroxidase test, and flow cytometry or microscopy. In addition, techniques have been identified to separate sperm samples from white blood cells and red blood cells for cryopreservation to improve outcomes in assisted reproductive technology. In this review, laboratory and clinical management of leukocytospermia and hematospermia are discussed. Currently available diagnostic methods and treatment options are outlined, and available optimal cryopreservation techniques for samples with white blood cells or red blood cells are summarized.

Transrectal ultrasound‑guided seminal vesicle catheterization with continuous antibiotic infusion for the treatment of refractory hematospermia

“…The majority of patients with hematospermia can heal on their own within a few weeks. Certain patients exhibit a recurrent blood presence in the semen that results in persistent or refractory hematospermia ( 6 ). These symptoms can give rise to anxiety in patients, leading to erectile dysfunction and infertility in certain more severe cases ( 10 ).…”

“…In addition, antibiotics are usually water soluble and exhibit acidity that lowers their dissociation constant, rendering them able to bind easily to proteins ( 9 ). These properties additionally limit the antibiotics' accessibility to the infected area and indicate that systemic medications do not exhibit a bactericidal effect in the prostate and seminal vesicles ( 6 , 9 ). Therefore, the prostate and seminal vesicle bacteria are difficult to eliminate, and the lesions are not easy to heal ( 12 ).…”

“…Persistent or recurrent hematospermia is often caused by non-specific inflammation or infection of the lower urinary tract, especially seminal vesiculitis and prostatitis ( 3 , 4 ). In some cases, pathologies such as benign urethral tumor or seminal vesicle malignancy may also present as hematospermia ( 5 , 6 ).…”

“…A thorough clinical work-up including the patients' medical history, sexual history, blood biochemistry, physical examination and examination of the ejaculate is recommended for assessing all patients presenting with the condition ( 6 ). In the majority of cases, hematospermia resolves without any treatment and in patients without any underlying cause of risk factors, only reassurance is sufficient to alleviate the patients anxiety ( 1 , 5 , 6 ). In the remaining patients, management of hematospermia depends on the underlying cause.…”

“…In cases of infections, empirical administration of antibiotics often treat the condition successfully ( 4 ). Surgical treatment may be required in cases of pathological abnormalities like cysts, vascular anomalies or calcifications ( 6 ). While the majority of patients with hematospermia are cured in a short period of time, a small number of patients relapse with persistent symptoms, and the management of these patients can be challenging ( 3 ).…”