eMedicine Specialties > Urology > Erectile Dysfunction, Premature Ejaculation, and Sexual Disorders

Hematospermia: Treatment & Medication

Author: Jonathan D Schiff, MD, Assistant Clinical Professor of Urology, Mount Sinai School of Medicine; Consulting Staff, Department of Urology, Mount Sinai Medical Center
Coauthor(s): John P Mulhall, MD, Director, Sexual Medicine Programs, Memorial Sloan-Kettering Cancer Center
Contributor Information and Disclosures

Updated: Nov 24, 2009

Treatment

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.

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.

More on Hematospermia

Overview: Hematospermia
Differential Diagnoses & Workup: Hematospermia
Treatment & Medication: Hematospermia
Follow-up: Hematospermia
References
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References

  1. Fletcher MS, Herzberg Z, Pryor JP. The aetiology and investigation of haemospermia. Br J Urol. Dec 1981;53(6):669-71. [Medline].

  2. Leary FJ, Aguilo JJ. Clinical significance of hematospermia. Mayo Clin Proc. Nov 1974;49(11):815-7. [Medline].

  3. Marshall VF, Fuller NL. Hemospermia. J Urol. Feb 1983;129(2):377-8. [Medline].

  4. Ganabathi K, Chadwick D, Feneley RC, et al. Haemospermia. Br J Urol. Mar 1992;69(3):225-30. [Medline].

  5. Berger AP, Gozzi C, Steiner H, et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. Apr 2004;171(4):1478-80; discussion 1480-1. [Medline].

  6. Han M, Brannigan RE, Antenor JA, et al. Association of hemospermia with prostate cancer. J Urol. 12 2004;172(6, Part 1 of 2):2189-2192. [Medline].

  7. Prando A. Endorectal magnetic resonance imaging in persistent hemospermia. Int Braz J Urol. Mar-Apr 2008;34(2):171-7; discussion 177-9. [Medline].

  8. Etherington RJ, Clements R, Griffiths GJ, et al. Transrectal ultrasound in the investigation of haemospermia. Clin Radiol. Mar 1990;41(3):175-7. [Medline].

  9. Furuya S, Kato H. A clinical entity of cystic dilatation of the utricle associated with hemospermia. J Urol. Sep 2005;174(3):1039-42. [Medline].

  10. Shen BY, Chang PL, Lee SH, Chen CL, Tsui KH. Complications following combined transrectal ultrasound-guided prostate needle biopsies and transurethral resection of the prostate. Arch Androl. Mar-Apr 2006;52(2):123-7. [Medline].

  11. Finney G, Haynes AM, Cross P, et al. Cross-sectional analysis of sexual function after prostate brachytherapy. Urology. Aug 2005;66(2):377-81. [Medline].

  12. Furuya S, Masumori N, Furuya R, et al. Characterization of localized seminal vesicle amyloidosis causing hemospermia: an analysis using immunohistochemistry and magnetic resonance imaging. J Urol. Apr 2005;173(4):1273-7. [Medline].

  13. Yu HH, Wong KK, Lim TK, et al. Clinical study of hemospermia. Urology. Dec 1977;10(6):562-3. [Medline].

  14. Bamberger E, Madeb R, Steinberg J, et al. Detection of sexually transmitted pathogens in patients with hematospermia. Isr Med Assoc J. Apr 2005;7(4):224-7. [Medline].

  15. Smith GW, Griffith DP, Pranke DW. Melanospermia: an unusual presentation of malignant melanoma. J Urol. Sep 1973;110(3):314-6. [Medline].

  16. Worischeck JH, Parra RO. Chronic hematospermia: assessment by transrectal ultrasound. Urology. Apr 1994;43(4):515-20. [Medline].

  17. Maeda H, Toyooka N, Kinukawa T, et al. Magnetic resonance images of hematospermia. Urology. May 1993;41(5):499-504. [Medline].

  18. Fuse H, Sumiya H, Ishii H, et al. Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography. J Urol. Nov 1988;140(5):991-2. [Medline].

  19. Li L, Jiang C, Song C, et al. Transurethral endoscopy technique with a ureteroscope for diagnosis and management of seminal tracts disorders: a new approach. J Endourol. Apr 2008;22(4):719-24. [Medline].

  20. Ashkar MF, Issa II. Bilharzial hematospermia. J Egyp Med Assoc. 1935;18:274.

  21. Aus G, Hermansson CG, Hugosson J, et al. Transrectal ultrasound examination of the prostate: complications and acceptance by patients. Br J Urol. Apr 1993;71(4):457-9. [Medline].

  22. Benson RC Jr, Clark WR, Farrow GM. Carcinoma of the seminal vesicle. J Urol. Sep 1984;132(3):483-5. [Medline].

  23. Cattolica EV. Massive hemospermia: a new etiology and simplified treatment. J Urol. Jul 1982;128(1):151-2. [Medline].

  24. Close CF, Yeo WW, Ramsay LE. The association between haemospermia and severe hypertension. Postgrad Med J. Feb 1991;67(784):157-8. [Medline].

  25. Collins GN, Lloyd SN, Hehir M, et al. Multiple transrectal ultrasound-guided prostatic biopsies--true morbidity and patient acceptance. Br J Urol. Apr 1993;71(4):460-3. [Medline].

  26. Craig SR. '3-in-1' nerve block complicated by haemospermia. Br J Clin Pract. Summer 1992;46(2):80. [Medline].

  27. Elem B, Patil PS. Haemospermia: observations in an area of endemic bilharziasis. Br J Urol. Aug 1987;60(2):170-3. [Medline].

  28. Geoghegan JG, Bonavia I. Haemospermia as a presenting symptom of lymphoma. Br J Urol. Dec 1990;66(6):658. [Medline].

  29. Gustafsson O, Norming U, Nyman CR, et al. Complications following combined transrectal aspiration and core biopsy of the prostate. Scand J Urol Nephrol. 1990;24(4):249-51. [Medline].

  30. Halim A, Vaezzadeh K. Hydatid disease of the genitourinary tract. Br J Urol. Apr 1980;52(2):75-8. [Medline].

  31. Hamburger S, Styczynski M, O'Hearne J, et al. Hemospermia and hypertension two case reports. J Kans Med Soc. Oct 1980;81(10):459-60. [Medline].

  32. Heller E, Whitesel JA. Seminal vesicle cysts. J Urol. Sep 1963;90:305-7. [Medline].

  33. Huggins C, McDonald DF. Chronic hemospermia: its origin and treatment with estrogen. J Clin Endocrin. 1945;5:226-31.

  34. Hugues J. La pathogenia de l'hemospermia. Gaz Hebd de Med. 1894;41:113-5.

  35. Iversen PS. [Hemospermia and hypertension]. Ugeskr Laeger. Feb 23 1987;149(9):596. [Medline].

  36. Jones DJ. Haemospermia: a prospective study. Br J Urol. Jan 1991;67(1):88-90. [Medline].

  37. Kawahara M, Matsuhashi M, Tajima M, et al. Primary carcinoma of seminal vesicle. Diagnosis assisted by sonography. Urology. Sep 1988;32(3):269-72. [Medline].

  38. Kenney PJ, Leeson MD. Congenital anomalies of the seminal vesicles: spectrum of computed tomographic findings. Radiology. Oct 1983;149(1):247-51. [Medline].

  39. Koment RW, Poor PM. Infection by human cytomegalovirus associated with chronic hematospermia. Urology. Dec 1983;22(6):617-21. [Medline].

  40. Kotsyn I. On bloody semen. Russk Med. 1893;18:136-8.

  41. Lembeli CM, Venkataramaiah NR. Schistosoma haematobium ova in semen. J Urol. Apr 1981;125(4):603. [Medline].

  42. Lemesh RA. Case report: recurrent hematuria and hematospermia due to prostatic telangiectasia in classic von Willebrand's disease. Am J Med Sci. Jul 1993;306(1):35-6. [Medline].

  43. Littrup PJ, Lee F, McLeary RD, et al. Transrectal US of the seminal vesicles and ejaculatory ducts: clinical correlation. Radiology. Sep 1988;168(3):625-8. [Medline].

  44. Magid MA, Hejtmancik JH. Hematospermia. J Urol. Jul 1957;78(1):82-88. [Medline].

  45. Ogreid P, Hatteland K. Cyst of seminal vesicle associated with ipsilateral renal agenesis. A report on four cases. Scand J Urol Nephrol. 1979;13(1):113-6. [Medline].

  46. Papp G, Molnar J. Causes and differential diagnosis of hematospermia. Andrologia. Sep-Oct 1981;13(5):474-8. [Medline].

  47. Parker G. Hemospermia. Proc Roy Soc Med. 1942;35:659-62.

  48. Pryor JP. Hemospermia. In: Whitfield HN, Hendry WF, eds. Textbook of Genitourinary Surgery. Edinburgh, Scotland: Churchill Livingstone; 1985:1208-11.

  49. Ross JC. Haemospermia. Practitioner. Jul 1969;202(213):59-62. [Medline].

  50. Secaf E, Nuruddin RN, Hricak H, et al. MR imaging of the seminal vesicles. AJR Am J Roentgenol. May 1991;156(5):989-94. [Medline].

  51. Silverman PM, Dunnick NR, Ford KK. Computed tomography of the normal seminal vesicles. Comput Radiol. Nov-Dec 1985;9(6):379-85. [Medline].

  52. Stein AJ, Prioleau PG, Catalona WJ. Adenomatous polyps of the prostatic urethra: a cause of hematospermia. J Urol. Aug 1980;124(2):298-9. [Medline].

  53. Søndergaard G, Vetner M, Christensen PO. Prostatic calculi. Acta Pathol Microbiol Immunol Scand [A]. May 1987;95(3):141-5. [Medline].

  54. Tolley DA, Castro JE. Hemospermia. Urology. Sep 1975;6(3):331-2. [Medline].

  55. Tripathi VN, Dick VS. Primary sarcoma of the urogenital system in adults. J Urol. Jun 1969;101(6):898-904. [Medline].

  56. Van Poppel H, Vereecken R, De Geeter P, et al. Hemospermia owing to utricular cyst: embryological summary and surgical review. J Urol. Mar 1983;129(3):608-9. [Medline].

  57. Walsh IK, Keane PF, Herron B. Benign urethral polyps. Br J Urol. Dec 1993;72(6):937-8. [Medline].

  58. Weidner W, Jantos C, Schumacher F, et al. Recurrent haemospermia--underlying urogenital anomalies and efficacy of imaging procedures. Br J Urol. Mar 1991;67(3):317-23. [Medline].

  59. Whyman MR, Morris DL. Retrovesical hydatid causing haemospermia. Br J Urol. Jul 1991;68(1):100-1. [Medline].

  60. Widdison AD, Feneley RC. Case report: Calculi in the ejaculate. Br J Sex Med. 1989;16:270-1. [Medline].

  61. Yada B. On the study of hemospermia. Hinyokika Kiyo. Apr 1963;9:175-206. [Medline].

  62. Yang SC, Rha KH, Byon SK, et al. Transutricular seminal vesiculoscopy. J Endourol. Aug 2002;16(6):343-5. [Medline].

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Further Reading

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Keywords

hematospermia, hemospermia, bloody sperm, bloody ejaculate, bloody seminal fluid, bloody semen, blood in the ejaculate, prostate lesions, prostatitis, acute bacterial prostatitis, prostate cancer, prostate telangiectasia, prostate varices, prostatic telangiectasia, prostatic varices, prostatic calculi, transrectal biopsy, urethritis, urethral lesions, urethral cysts, urethral polyps, urethral condylomata, urethral strictures, urethral stricture disease, seminal vesicle cysts, genitourinary TB, genitourinary tuberculosis, schistosomiasis, urethral trauma, hemorrhoidal sclerosing injection, urethral self-instrumentation, testicular blunt trauma, perineal blunt trauma

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Contributor Information and Disclosures

Author

Jonathan D Schiff, MD, Assistant Clinical Professor of Urology, Mount Sinai School of Medicine; Consulting Staff, Department of Urology, Mount Sinai Medical Center
Jonathan D Schiff, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

John P Mulhall, MD, Director, Sexual Medicine Programs, Memorial Sloan-Kettering Cancer Center
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.

Medical Editor

Edmund S Sabanegh Jr, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Edmund S Sabanegh Jr, MD is a member of the following medical societies: American College of Surgeons, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
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: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

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, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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