The presence of blood in the semen is known as hematospermia. Men who experience blood in their ejaculate may get concerned.
The incidence of hematospermia is unknown because the disorder is prevalent and many cases were unreported. Hematospermia might be the initial sign of systemic and other urologic conditions.
Male fertility depends on the production and storage of seminal fluid, which is produced by the androgen-dependent auxiliary organs known as seminal vesicles.
Areas of higher echogenicity correlate to the folds of secretory epithelium, while the seminal vesicle’s core is homogenous in its typical collapsed form.
Age has no effect on the size of the seminal vesicles, but neither does the condition of ejaculation. Seminal vesicle size has been shown to vary depending on the patient’s age and the extent of prostatic hypertrophy.
The vasa deferentia serve as conduits, transporting sperm through the vasal ampullae between the ejaculatory ducts and the epididymis.
The best way to observe the vasal ampullae is with transaxial transrectal ultrasonography (TRUS) views, which pass medially to the seminal vesicles.
Epidemiology
According to an analysis of an insurance claims database from the United States from 2010 to 2018, the average yearly incidence rate of hematospermia rose from 56.6 per 100,000 in 2010 to 73.6 per 100,000 in 2018.
After a TRUS-guided prostate biopsy, data indicate that up to 36.3% of men who had 6–15 cores removed experience post procedure hematospermia.
The frequency of hematospermia was not much increased by increasing the number of cores.
Males of any age can develop hemospermia. Hematospermia in younger males is consistently benign.
In 15,106 individuals under 40 years old, a nationally representative US database revealed only one cancer diagnosis.
Anatomy
Pathophysiology
The ejaculatory duct is formed by the union of the seminal vesicles and vasal ampullae.
At the verumontanum level, the ejaculatory duct passes past the prostate and enters the urethra. It is challenging to visualize the seminal vesicle-ejaculatory duct junction in a healthy, unobstructed system since it is located inside the prostate.
Small echodensities are commonly observed near the urethral junction of the verumontanum and the ejaculatory ducts.
The seminal vesicles, ejaculatory ducts, or prostate are the usual sources of blood, where delicate arteries may burst.
Etiology
The causes of hematospermia are as follows:
Seminal vesicle lesions
Infection
Accidental and surgical trauma
Systemic disorders
Genetics
Prognostic Factors
Hematospermia often resolves on its own, but if it is a sign of an underlying urologic condition, the prognosis is contingent upon the underlying condition.
An extended duration of hematospermia was independently predicted by a high urine pH or any aberrant findings on prostate imaging scans, according to Japanese research of 198 hematospermia patients.
The likelihood of chronic hematospermia was particularly high in patients with both of those characteristics.
They made up a substantially larger percentage of the group whose hematospermia lasted more than six months as opposed to the group whose hematospermia lasted less than two months.
Clinical History
Collect details including presenting complaint, sexual/reproductive, past medical and surgical history of patients.
Physical Examination
Genitourinary Examination
Lymphatic Examination
Abdominal Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Single or sudden episode of blood in semen, prolonged abstinence
Chronic symptoms are:
Hematuria, Lower urinary tract symptoms, weight loss, bone pain
Differential Diagnoses
Calculi of the prostate or seminal vesicles
Bleeding disorders
Tuberculosis of the Genitourinary System
Malignancy of the seminal vesicles
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The main objective in the treatment of hematospermia is to appropriately advise patients who suffer from a condition that can cause a great deal of concern but is usually benign and self-limiting.
The hematospermia’s length and recurrence More intensive intervention is necessary to determine the etiologic cause for chronic hematospermia.
If an infectious etiology is suspected in younger men, concurrent treatment for chlamydial infections should also be employed.
Both organisms should get appropriate treatment from a fluoroquinolone. Rarely is hematospermia linked to serious illness in younger men.
For urogenital chlamydial infections, the Centers for Disease Control and Prevention’s current guidelines suggest levofloxacin as an alternate treatment option, but they also advise taking 100 mg of doxycycline orally twice daily for seven days.
A combination of trimethoprim/sulfamethoxazole and doxycycline is frequently effective if the patient is allergic to fluoroquinolones or cannot afford this pharmaceutical class.
Ibuprofen and other nonsteroidal anti-inflammatory medications can be used to manage concurrent inflammation.
Patients who have hematospermia and bleeding prostatic variceal veins are candidates for fulguration.
Bugbee or loop electrode can be used for fulguration if big friable prostatic veins are seen and the rest of the diagnostic results are normal.
Using a semirigid ureteroscope to cannulate the ejaculatory duct, endoscopy of the ejaculatory ducts and seminal vesicles enables the surgeon to examine the duct, seminal vesicle, and vas ampulla.
use-of-phases-in-managing-hematospermia
In initial phase, the goal is to check history, examination, and reassurance of patient.
In environmental phase, the goal is to avoid perineal trauma, follow safe sexual practices, and control systemic illnesses.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the urologist are scheduled to check the improvement of patients along with treatment response.
The presence of blood in the semen is known as hematospermia. Men who experience blood in their ejaculate may get concerned.
The incidence of hematospermia is unknown because the disorder is prevalent and many cases were unreported. Hematospermia might be the initial sign of systemic and other urologic conditions.
Male fertility depends on the production and storage of seminal fluid, which is produced by the androgen-dependent auxiliary organs known as seminal vesicles.
Areas of higher echogenicity correlate to the folds of secretory epithelium, while the seminal vesicle’s core is homogenous in its typical collapsed form.
Age has no effect on the size of the seminal vesicles, but neither does the condition of ejaculation. Seminal vesicle size has been shown to vary depending on the patient’s age and the extent of prostatic hypertrophy.
The vasa deferentia serve as conduits, transporting sperm through the vasal ampullae between the ejaculatory ducts and the epididymis.
The best way to observe the vasal ampullae is with transaxial transrectal ultrasonography (TRUS) views, which pass medially to the seminal vesicles.
According to an analysis of an insurance claims database from the United States from 2010 to 2018, the average yearly incidence rate of hematospermia rose from 56.6 per 100,000 in 2010 to 73.6 per 100,000 in 2018.
After a TRUS-guided prostate biopsy, data indicate that up to 36.3% of men who had 6–15 cores removed experience post procedure hematospermia.
The frequency of hematospermia was not much increased by increasing the number of cores.
Males of any age can develop hemospermia. Hematospermia in younger males is consistently benign.
In 15,106 individuals under 40 years old, a nationally representative US database revealed only one cancer diagnosis.
The ejaculatory duct is formed by the union of the seminal vesicles and vasal ampullae.
At the verumontanum level, the ejaculatory duct passes past the prostate and enters the urethra. It is challenging to visualize the seminal vesicle-ejaculatory duct junction in a healthy, unobstructed system since it is located inside the prostate.
Small echodensities are commonly observed near the urethral junction of the verumontanum and the ejaculatory ducts.
The seminal vesicles, ejaculatory ducts, or prostate are the usual sources of blood, where delicate arteries may burst.
The causes of hematospermia are as follows:
Seminal vesicle lesions
Infection
Accidental and surgical trauma
Systemic disorders
Hematospermia often resolves on its own, but if it is a sign of an underlying urologic condition, the prognosis is contingent upon the underlying condition.
An extended duration of hematospermia was independently predicted by a high urine pH or any aberrant findings on prostate imaging scans, according to Japanese research of 198 hematospermia patients.
The likelihood of chronic hematospermia was particularly high in patients with both of those characteristics.
They made up a substantially larger percentage of the group whose hematospermia lasted more than six months as opposed to the group whose hematospermia lasted less than two months.
Collect details including presenting complaint, sexual/reproductive, past medical and surgical history of patients.
Genitourinary Examination
Lymphatic Examination
Abdominal Examination
Acute symptoms are:
Single or sudden episode of blood in semen, prolonged abstinence
Chronic symptoms are:
Hematuria, Lower urinary tract symptoms, weight loss, bone pain
Calculi of the prostate or seminal vesicles
Bleeding disorders
Tuberculosis of the Genitourinary System
Malignancy of the seminal vesicles
The main objective in the treatment of hematospermia is to appropriately advise patients who suffer from a condition that can cause a great deal of concern but is usually benign and self-limiting.
The hematospermia’s length and recurrence More intensive intervention is necessary to determine the etiologic cause for chronic hematospermia.
If an infectious etiology is suspected in younger men, concurrent treatment for chlamydial infections should also be employed.
Both organisms should get appropriate treatment from a fluoroquinolone. Rarely is hematospermia linked to serious illness in younger men.
For urogenital chlamydial infections, the Centers for Disease Control and Prevention’s current guidelines suggest levofloxacin as an alternate treatment option, but they also advise taking 100 mg of doxycycline orally twice daily for seven days.
A combination of trimethoprim/sulfamethoxazole and doxycycline is frequently effective if the patient is allergic to fluoroquinolones or cannot afford this pharmaceutical class.
Ibuprofen and other nonsteroidal anti-inflammatory medications can be used to manage concurrent inflammation.
Urology
Avoid too many or intense sex sessions that might damage the prostate and seminal vesicles.
A lengthy period of abstinence can increase the risk of seminal vesicle congestion and stasis.
Adequate rest and stress management should be done to reduce systemic exacerbations.
Patient should maintain optimal blood pressure through diet, exercise, and stress reduction.
Avoid smoking, drinking, and using recreational drugs as they show an impact on coagulation and vascular health.
Proper awareness about hematospermia should be provided and its related causes with management strategies.
Appointments with urologist and preventing recurrence of disorder is an ongoing life-long effort.
Urology
Ciprofloxacin:
It inhibits relaxation of DNA to promote breakage of double-stranded DNA.
Doxycycline:
It inhibits protein synthesis and that causes RNA-dependent protein synthesis to arrest.
Trimethoprim:
It inhibits dihydrofolate reductase that causes inhibition of microorganism growth.
Urology
Ibuprofen:
At least two cyclo-oxygenase (COX) isoenzymes are inhibited, which prevents the body’s tissues from synthesizing prostaglandins.
Urology
Patients who have hematospermia and bleeding prostatic variceal veins are candidates for fulguration.
Bugbee or loop electrode can be used for fulguration if big friable prostatic veins are seen and the rest of the diagnostic results are normal.
Using a semirigid ureteroscope to cannulate the ejaculatory duct, endoscopy of the ejaculatory ducts and seminal vesicles enables the surgeon to examine the duct, seminal vesicle, and vas ampulla.
Urology
In initial phase, the goal is to check history, examination, and reassurance of patient.
In environmental phase, the goal is to avoid perineal trauma, follow safe sexual practices, and control systemic illnesses.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the urologist are scheduled to check the improvement of patients along with treatment response.
The presence of blood in the semen is known as hematospermia. Men who experience blood in their ejaculate may get concerned.
The incidence of hematospermia is unknown because the disorder is prevalent and many cases were unreported. Hematospermia might be the initial sign of systemic and other urologic conditions.
Male fertility depends on the production and storage of seminal fluid, which is produced by the androgen-dependent auxiliary organs known as seminal vesicles.
Areas of higher echogenicity correlate to the folds of secretory epithelium, while the seminal vesicle’s core is homogenous in its typical collapsed form.
Age has no effect on the size of the seminal vesicles, but neither does the condition of ejaculation. Seminal vesicle size has been shown to vary depending on the patient’s age and the extent of prostatic hypertrophy.
The vasa deferentia serve as conduits, transporting sperm through the vasal ampullae between the ejaculatory ducts and the epididymis.
The best way to observe the vasal ampullae is with transaxial transrectal ultrasonography (TRUS) views, which pass medially to the seminal vesicles.
According to an analysis of an insurance claims database from the United States from 2010 to 2018, the average yearly incidence rate of hematospermia rose from 56.6 per 100,000 in 2010 to 73.6 per 100,000 in 2018.
After a TRUS-guided prostate biopsy, data indicate that up to 36.3% of men who had 6–15 cores removed experience post procedure hematospermia.
The frequency of hematospermia was not much increased by increasing the number of cores.
Males of any age can develop hemospermia. Hematospermia in younger males is consistently benign.
In 15,106 individuals under 40 years old, a nationally representative US database revealed only one cancer diagnosis.
The ejaculatory duct is formed by the union of the seminal vesicles and vasal ampullae.
At the verumontanum level, the ejaculatory duct passes past the prostate and enters the urethra. It is challenging to visualize the seminal vesicle-ejaculatory duct junction in a healthy, unobstructed system since it is located inside the prostate.
Small echodensities are commonly observed near the urethral junction of the verumontanum and the ejaculatory ducts.
The seminal vesicles, ejaculatory ducts, or prostate are the usual sources of blood, where delicate arteries may burst.
The causes of hematospermia are as follows:
Seminal vesicle lesions
Infection
Accidental and surgical trauma
Systemic disorders
Hematospermia often resolves on its own, but if it is a sign of an underlying urologic condition, the prognosis is contingent upon the underlying condition.
An extended duration of hematospermia was independently predicted by a high urine pH or any aberrant findings on prostate imaging scans, according to Japanese research of 198 hematospermia patients.
The likelihood of chronic hematospermia was particularly high in patients with both of those characteristics.
They made up a substantially larger percentage of the group whose hematospermia lasted more than six months as opposed to the group whose hematospermia lasted less than two months.
Collect details including presenting complaint, sexual/reproductive, past medical and surgical history of patients.
Genitourinary Examination
Lymphatic Examination
Abdominal Examination
Acute symptoms are:
Single or sudden episode of blood in semen, prolonged abstinence
Chronic symptoms are:
Hematuria, Lower urinary tract symptoms, weight loss, bone pain
Calculi of the prostate or seminal vesicles
Bleeding disorders
Tuberculosis of the Genitourinary System
Malignancy of the seminal vesicles
The main objective in the treatment of hematospermia is to appropriately advise patients who suffer from a condition that can cause a great deal of concern but is usually benign and self-limiting.
The hematospermia’s length and recurrence More intensive intervention is necessary to determine the etiologic cause for chronic hematospermia.
If an infectious etiology is suspected in younger men, concurrent treatment for chlamydial infections should also be employed.
Both organisms should get appropriate treatment from a fluoroquinolone. Rarely is hematospermia linked to serious illness in younger men.
For urogenital chlamydial infections, the Centers for Disease Control and Prevention’s current guidelines suggest levofloxacin as an alternate treatment option, but they also advise taking 100 mg of doxycycline orally twice daily for seven days.
A combination of trimethoprim/sulfamethoxazole and doxycycline is frequently effective if the patient is allergic to fluoroquinolones or cannot afford this pharmaceutical class.
Ibuprofen and other nonsteroidal anti-inflammatory medications can be used to manage concurrent inflammation.
Urology
Avoid too many or intense sex sessions that might damage the prostate and seminal vesicles.
A lengthy period of abstinence can increase the risk of seminal vesicle congestion and stasis.
Adequate rest and stress management should be done to reduce systemic exacerbations.
Patient should maintain optimal blood pressure through diet, exercise, and stress reduction.
Avoid smoking, drinking, and using recreational drugs as they show an impact on coagulation and vascular health.
Proper awareness about hematospermia should be provided and its related causes with management strategies.
Appointments with urologist and preventing recurrence of disorder is an ongoing life-long effort.
Urology
Ciprofloxacin:
It inhibits relaxation of DNA to promote breakage of double-stranded DNA.
Doxycycline:
It inhibits protein synthesis and that causes RNA-dependent protein synthesis to arrest.
Trimethoprim:
It inhibits dihydrofolate reductase that causes inhibition of microorganism growth.
Urology
Ibuprofen:
At least two cyclo-oxygenase (COX) isoenzymes are inhibited, which prevents the body’s tissues from synthesizing prostaglandins.
Urology
Patients who have hematospermia and bleeding prostatic variceal veins are candidates for fulguration.
Bugbee or loop electrode can be used for fulguration if big friable prostatic veins are seen and the rest of the diagnostic results are normal.
Using a semirigid ureteroscope to cannulate the ejaculatory duct, endoscopy of the ejaculatory ducts and seminal vesicles enables the surgeon to examine the duct, seminal vesicle, and vas ampulla.
Urology
In initial phase, the goal is to check history, examination, and reassurance of patient.
In environmental phase, the goal is to avoid perineal trauma, follow safe sexual practices, and control systemic illnesses.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the urologist are scheduled to check the improvement of patients along with treatment response.
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