Haematospermia
Gordon Smyth
SpR Teaching
Feb 14th 2005
Introduction
• Haematospermia refers to the presence of
blood in the seminal fluid
• Provokes great anxiety in patients
• Fearful of cancer, STDs, threat to sex life
• Aetiology diverse and poorly understood
• Prevalence in general population and
incidence in GUM settings unknown
• Incidence in urology 1:5000 new cases
Leary et al. Mayo Clinic Proc. 1974
Introduction
• Can occur in men of any age (mean 37 years)
• Site of origin could be prostate, seminal vesicle,
testes, epididymis, vas deferens, urethra,
bladder
• Usually:
– acute onset
– Recurrent
– Self limiting (usually resolves within several weeks)
• Rarely:
– Severe, postcoital haematuria, clot formation
Introduction
• May be only symptom or associated with
other urological symptoms such as
dysuria, testicular pain, prostatism,
heamaturia
• Emission and ejacualation must be
present
• Erection is not necessary
Aetiology
• Inflammation
• Iatrogenic (Prostate needle biopsy)
• Vascular abnormalities
• Ductal obstruction or cysts
• Tumours
• Systemic disease
• Drugs
Aetiology
• Relative frequency with which definite
pathology is detected is directly related to
degree of investigation
• Most due to inflammation, infection and
iatrogenic
• Malignancy is rare but should be
considered in patients >40 years
Leary et al. Clinical significance of
haematospermia. Mayo Clin Proc 1974;49:815-17
• Review of 200 patients, 15 years
• Physical exam, DRE, MSU all patients
• 174 cysto and KUB
• 64 patients minor abnormalities
• No incidence of significant urological disease
• 150 patients followed for 5 – 23 years
• 44 persistent haematuria
• None developed any significant disease
Fletcher et al. The aetiology and investigation of
haematospermia. Br J Urol 1981;53:669-71
• 81 patients 1976-1980
• Physical exam, DRE in all
• Further tests included prostatic massage, MSU, AFB,
seminal analysis, IVU, cysto and prostate biopsy as
indicated
• 86% cause was discovered
• 80% of these cause was infection (esp 40 years (n=9)
cause found in all pts
one CaP age 73 years
Papp et al. Haematospermia. J Androl 1994;15
Suppl:31S-33S
• N=84
• Progressive diagnostic approach
• Physical examination, semen analysis, TRUS, CT, MRI,
vasography, voiding urethrography
• Most frequent finding is prostatic disease (41.6%)
• Especially prostatic calculi (20.2%)
• Malignant disease in 11.8%
• Unexplained in 15.4%
Conclusion
• Most cases benign and self-limiting
• Most patients 40 years
– Recurrent or persistent
– Associated symptoms or very worried