Hemospermia - Definition : the presence of blood in the semen. Usually
intermittent, benign, self-limiting and no cause identified.
Causes
: Age <40 years: usually inflammatory (e.g. prostatitis,
epididymo-orchitis, urethritis, urethral warts) or idiopathic (though to an
extent this reflects the limited investigation that is usually carried out in
this age group). Rarely testicular tumour; perineal or testicular trauma. Age
>40 years: as for men aged <40—prostate cancer; bladder cancer; BPH;
dilated veins in the prostatic urethra; prostatic or seminal vesicle calculi;
hypertension; carcinoma of the seminal vesicles. Rare causes at any age:
bleeding diathesis; utricular cysts; ullerian cysts; TB; schistosomiasis;
amyloid of prostate or seminal vesicles; post-injection of
haemorrhoids.
Examination : Examine the testes, epididymis, prostate, and
seminal vesicles. Measure blood pressure.
Investigation : Send urine for
culture. If the hemospermia resolves, an argument can be made for doing nothing
else. If it recurs or persists, arrange a transrectal ultrasound (TRUS),
flexible cystoscopy, and renal ultrasound. If haematuria coexists, investigate
this as described above.
Treatment : This is directed at the underlying
abnormality, if found.
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