Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia.
The goal of this study was to explore minimally invasive transurethral  imaging and surgery for the treatment of severe, persistent hematospermia in  cases that were refractory to conservative treatments. The study included 43  patients (aged 22-77 years; average, 44.6 years) with long-lasting,  severe hematospermia, accompanied by discomfort or pain in the lumbosacral or  perineal region, dysuria, frequent micturition, decreased semen volume, and/or  azoospermia. Patient symptoms had persisted for 1 to 10 years (average, 5.3  years). Computed tomography or magnetic resonance imaging of each patient was  evaluated, and transurethral surgery was performed. The causes of  hematospermia were identified in all 43 patients, and their ejaculatory duct  obstruction or seminal vesiculitis was successfully treated. No serious  intraoperative or postoperative complications occurred. Pathologic analyses  revealed that all of the resected or biopsied seminal vesicle tissues had  chronic nonspecific inflammation in the seminal vesicle wall, and no tumors  were identified. Preoperative symptomology of hematospermia disappeared in all  patients followed up for 2 to 30 months (average, 16 months). A single patient  experienced recurrence at 11 months and had a second minimally invasive  surgery that was curative. A total of 95.3% (41 of 43) of the patients  experienced normal orgasmic intensity after surgery. Magnetic resonance  imaging is a valuable and accurate diagnostic method for the identification of  causative factors underlying hematospermia. Transurethral dilation of  ejaculatory ducts, incision of the verumontanum or the distal end of the  ejaculatory ducts, and incision or resection of the relevant cysts represent  simple, safe, and reliable approaches for the management of refractory cases  of hematospermia that do not respond to conservative treatments.
Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10, Daping Changjiangzhilu, Yuzhong district, Chongqing 400042, China.
Yan-Feng
YF
Li
Pei-He
PH
Liang
Zhong-Yi
ZY
Sun
Yong
Y
Zhang
Gang
G
Bi
Bo
B
Zhou
Ke
K
Li
Wei
W
Bai
Luo-Fu
LF
Wang
Jun
J
Zhang
Feng-Shuo
FS
Jin
D000328:Adult; D000368:Aged; D001706:Biopsy; D003952:Diagnostic Imaging / Q000379:methods; D004724:Endoscopy; D005837:Genitalia, Male / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D051516:Hemospermia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D055101:Semen Analysis; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D013521:Urologic Surgical Procedures, Male; D055815:Young Adult