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Hematospermia: Causes and Evaluation Nov 2020 Vol Jaffal et al (2020): Hematospermia: Causes and Evaluation Nov 2020 Vol. 23 Issue 18 Hematospermia: Causes and Evaluation (A local study) Waleed Nassar Jaffal1, Duraid Taha Abdulkareem2, Ehab Jasim Mohammad3 1Ass. Professor, FICMS, MBChB, Consultant urologist, Head of Department of Surgery, College of Medicine, ‎University of Anbar, Anbar, Iraq. 2Lecturer of urology, FIBMS, FABHS, M.B.CH.B. University of Anbar, college of medicine,Iraq 3Professor, FEBU, ,FICMS, MBChB, Consultant Urologist, Head of Department of Surgery, College of Medicine, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq *Corresponding author: EhabJasim Mohammad ([email protected]) Abstract: Objectives: To assess the possible causes of hematospermia.Patients and methods: From October 2013 to October 2019, 169 patients presenting with hematospermia in Al Ramadi teaching hospital and private urologist clinic were included in this observational prospective study. The patients were divided into 2 groups according to the age; group A for those who are younger than 40 years and group B for those who are 40 years and older. Complete physical examination and digital rectal examination (DRE) done for every patient, all patients were evaluated by urinalysis, urine culture, complete blood count, serum uric acid measurement, abdominal and /or transrectal ultrasonography, prostatic specific antigen (PSA) and seminal fluid analysis, in addition to urine cytology, polymerase chain reaction (PCR) for urinary tuberculosis, excretory urography, CT scan, MRI, prostatic biopsy and cystoscopy in selected cases.Result:The mean age of patient was 55+10.5 sd ranging from 25 to 75 years. The identified causes in group A are sexually transmitted diseases in 30 patients, prostatitis in 17 patients, sever hypertension in 10 cases, hyperuricemia in 5 cases, vigorous sexual intercourse in 5 cases, prostatic calculi in 5 case, seminal vesicle calculi in 2 cases, bleeding tendency in one case, urinary tuberculosis in one case and no identifiable causes in the remaining 13 patients. The identified causes in group B are benign prostatic hyperplasia in 32 cases, sever hypertension in 15 cases, active urinary tract infection in 8 cases, prostatic calculi in 6 cases, prostatic cancer in 4 cases, bleeding tendency in 3 cases and no identifiable causes in the remaining 13.Conclusion: The causes of hematospermia are mostly benign as occurrence of serious pathology was rare but patients with alarming features as older age, persistent hematospermia or recurrent hematospermia should have thorough assessment to identify curable diseases and to rule out malignancy. Key word: hematospermia, seminal fluid, prostatic cancer How to cite this article: Jaffal WN, Abdulkareem DT, Mohammed EJ (2020): Hematospermia: Causes and evaluation (A local study), Ann Trop Med & Public Health; 23(S18): SP231827. DOI: http://doi.org/10.36295/ASRO.2020.231827 Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.231827 Jaffal et al (2020): Hematospermia: Causes and Evaluation Nov 2020 Vol. 23 Issue 18 Introduction Hematospermia is the presence of blood in the ejaculated human seminal fluid. Despite being a usually an alarming sign and cause fear and big concern to the patient, the causes are commonly benign. Hematospermia is mostly never a sign of malignancy in younger patients. (1,2)The color of ejaculate after the occurrence of bleeding event in hematospermia depends on the time since bleeding. Light red to brownish color means fresh blood, but if some time has elapsed after the occurrence of bleeding, the color will be darker and even dark brown or black blood clots may be seen. Hematospermia is mostly painless and noticed incidentally by the patient or his partner.(3)Among the common causes of hematospermia are transrectal prostatic biopsy, radiotherapy for cancer of the prostate and bilateral vasectomies but in these cases, the cause is known to the patient and don't make any concern to the patient.(4)Therefore, in this study we will exclude these causes and concentrate on other unobvious causes to the patient and the physician and these causes make concern to the patients. The causes are often classified into different pathophysiological mechanisms. Mostly they are iatrogenic, inflammatory and infective in origin. The differential diagnosis of hematospermia may include the following causes; inflammatory and infectivepathologies of the prostate or seminal vesicles, hypertension, calculi of the prostate or seminal vesicles, tuberculosis of the prostate, seminal vesicles, vas deferens or the testes, bleeding tendencies, prostate cancer, cancer of the seminal vesicles, prostatic veins varices, hyperuricemia and trauma.(5-10)The standard and the ideal investigation for haematospermia is unknown. There is great concern regarding the association of hematospermia with pathology especially prostatic cancer and there is little evidence based literature regarding this association.(11)In most patients hematospermia is a benign and self-limiting symptom, but some patients who are suffering from recurrent or persistent hematospermia may have more serious underlying organic pathological causes, and further evaluation may be indicated to get rid of their great anxiety, fear, stress, and concern.(12) Objectives: To assess the possible causes of hematospermia Patients and methods: from October 2013 to October 2019, 169 patients presenting with hematospermia in Al Ramadi teaching hospital and private urologist clinic were included in this observational prospective study. The patients divided into 2 groups according to the age; group A for those who are younger than 40 years and group B for those who are40 years and older. Patients with diagnosed prostatic cancer, patients undergoing prostatic biopsy were excluded from this study. For all patients: age, marital status, duration of hematospermia was recorded in addition to detailed and thorough medical and surgical history was obtained. Complete physical examination and digital rectal examination (DRE) done for every patient, all patients were evaluated by urinalysis, urine culture, complete blood count, serum uric acid measurement, abdominal and/or transrectal ultrasonography, prostatic specific antigen (PSA) and seminal fluid analysis, in addition to urine cytology, PCR for urinary tuberculosis, excretory urography, CT scan, MRI, prostatic biopsy and cystoscopy in selected cases. Informed consent was obtained from each patient and the study approved by the ethical committee at the collegeof medicine. Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.231827 Jaffal et al (2020): Hematospermia: Causes and Evaluation Nov 2020 Vol. 23 Issue 18 Result: The mean age of patient was 55+ 10.5 SD ranging from 25 to 75 years. The number of patients who are younger than 40 years are 88 patients (group A) and the number of patients who are 40 years and older was 81 patients (group B). The identified causes in group Aare sexually transmitted diseases in 30 patients, prostatitis in 17 patients, sever hypertension in 10 cases, hyperuricemia in 5 cases, vigorous sexual intercourse in 5 cases, prostatic calculi in 5 case, seminal vesicle calculi in 2 cases, bleeding tendency in one case, urinary tuberculosis in one case and no identifiable causes in the remaining 12 patients. Table 1 The identified causes in group B are benign prostatic hyperplasia in 32 cases, sever hypertension in 15 cases, active urinary tract infection in 8 cases, prostatic calculi in 6 cases, prostatic cancer in 4 cases, bleeding tendency in 3 cases and no identifiable causes in the remaining 13 patients. Table 2 In all patients of both groups the causes were benign prostatic hyperplasia in 18.9% of patients, sexually transmitted diseases in 17.8%, sever hypertensionin 14.8%, prostatitis in in 10.1%, Prostatic calculiin 6.5%, active urinary tract infection in 4.7%, hyperuricemiain 2.95%, vigorous sexual intercoursein 2.95%, prostatic cancerin 2.4%, bleeding tendency in 2.4%, seminal vesicle calculi in 1.2%, urinary tuberculosis in 0.6 % and remained unknown in 14.2%. Table 3 and Figure 1 Idiopathic Table 1: Causes of hematospermia in group A (88 patients) The cause Number Percentage Sexually transmitted diseases 30 34 Prostatitis 17 19.3 Sever hypertension 10 11.4 Hyperuricemia 5 5.9 Vigorous sexual intercourse 5 5.9 Prostatic calculi 5 5.9 Seminal vesicle calculi 2 2.3 Bleeding tendency 1 1.1 Urinary tuberculosis 1 1.1 Idiopathic 12 13.6 Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.231827 Jaffal et al (2020): Hematospermia: Causes and Evaluation Nov 2020 Vol. 23 Issue 18 Table 2: Causes of hematospermia in group B (81 patients) The cause Number Percentage Benign prostatic hyperplasia 32 39.5 Sever hypertension 15 18.5 Active urinary tract infection 8 9.9 Prostatic calculi 6 7.4 Prostatic cancer 4 4.9 Bleeding tendency 3 3.7 Idiopathic 13 1.6 Table 3:The overall causes in all patients (both groups) The cause Number Percentage Benign prostatic hyperplasia 32 18.9 Sexually transmitted diseases 30 17.8 Sever hypertension 25 14.8 Prostatitis 17 10.1 Prostatic calculi 11 6.5 Active urinary tract infection 8 4.7 Hyperuricemia 5 2.95 Vigorous sexual intercourse 5 2.95 Prostatic cancer 4 2.4 Bleeding tendency 4 2.4 Seminal vesicle calculi 2 1.2 Urinary tuberculosis 1 0.6 Idiopathic 24 14.2 Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2020.231827 Jaffal et al (2020): Hematospermia: Causes and Evaluation
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