Hematospermia Treatment & Management

  • Author: Jonathan D Schiff; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Apr 14, 2010
 

Medical Care

  • The primary goal in the management of hematospermia is to allay the anxiety of the frightened patient. Hematospermia is rarely associated with significant pathology, especially in younger men. The 3 factors that dictate the extent of the evaluation and treatment include (1) patient age, (2) the duration and recurrence of the hematospermia, and (3) the presence of any associated hematuria. Most malignancies associated with hematospermia occur in patients older than 40 years. Chronic hematospermia warrants more aggressive intervention to identify an etiologic factor.
  • In younger men with nonpersistent hematospermia, only a DRE (along with a check of vital signs) is required as part of a careful physical examination. In older men (>50 y) with nonpersistent hematospermia without concomitant hematuria upon urinalysis, a basic evaluation consists of a DRE and a prostate-specific antigen measurement. All patients with concomitant hematuria need an evaluation of their upper (with intravenous pyelography, renal ultrasonography, or spiral CT scan) and lower tracts (with cystoscopy). Persistent hematospermia (>2 mo without defined etiology) warrants a full workup as described in Workup.
  • Urogenital infections require appropriate antibiotic therapy, which normally resolves the problem. In all men, enterobacteria (especially Escherichia coli) should be covered. In younger men, concomitant therapy for chlamydial infections should also be used. A fluoroquinolone should adequately treat both organisms. If the patient is allergic to fluoroquinolones or cannot afford this class of drugs, a combination of trimethoprim/sulfamethoxazole and doxycycline is often successful. A 2-week course is usually sufficient. Concomitant inflammation may be treated with ibuprofen or other nonsteroidal anti-inflammatory medications.
  • Urethral or prostatic varices are best fulgurated, while cysts, of either the seminal vesicles or prostatic urethra, can be aspirated transrectally. Fuse and colleagues injected coagulant substances into dilatated seminal vesicles under TRUS guidance in 7 patients with hematospermia. The hematospermia was transiently resolved by this maneuver for a maximum duration of 3 months, at which time the condition recurred.[18] Therefore, currently, no evidence suggests that the injection of any substance, coagulant or sclerosant, has any role in the management of hematospermia.
  • Bleeding diatheses or other systemic disorders should be managed in the appropriate manner.
  • In men with coexisting bladder outlet obstruction, a 5-alpha reductase inhibitor may be used.
  • No rationale currently exists for the use of oral agents, such as estrogens or corticotrophins, which have been used in the past.
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Surgical Care

Patients in whom bleeding prostatic variceal veins are suggested as the cause of hematospermia are candidates for fulguration. After infectious causes have been excluded in cases of persistent hematospermia, cystourethroscopy is performed. If large friable prostatic veins are discovered and examination findings are otherwise normal, fulguration with a Bugbee or loop electrode can be performed. Prior to fulguration, a biopsy should be performed on any suggestive lesions.

More recently, a technique of endoscopy of the ejaculatory ducts and seminal vesicles has been described.[19] This technique involves using a semirigid ureteroscope to cannulate the ejaculatory duct and allows the surgeon to examine the duct, seminal vesicle, and ampulla of the vas. However, the author reserves this technique for only the most refractory cases of hemospermia that cause significant physiologic (urinary retention or persistent hematuria) or psychological (avoidance of ejaculation) trauma.

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Contributor Information and Disclosures
Author

Jonathan D Schiff  MD, Assistant Clinical Professor of Urology, Department of Urology, Mount Sinai Medical Center; Adjunct Assistant Clinical Professor of Urology, Weill-Cornell School of Medicine

Jonathan D Schiff is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

from Memorial Sloan-Kettering – John P Mulhall, MD  Director, Sexual and Reproductive Medicine Program, Memorial Sloan-Kettering Cancer Center

from Memorial Sloan-Kettering – John P Mulhall, MD is a member of the following medical societies: American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for Basic Urologic Research, and Society of University Urologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Edmund S Sabanegh Jr, MD  Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh Jr, MD is a member of the following medical societies: American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

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