CJK 01. Current management of hemospermia
Hemospermia is defined as the fresh or altered blood in the ejaculate, which shows distinct clinical impact including severe anxiety-provoking sign in aspect of patient, but easy neglect to urologist.
The incidence of hemospermia is difficult to quantify because most men do not observe their semen. Prevalence in clinical settings is highest in men younger than 40 years. The etiology of hemospermia is broad-spectrum like hematuria, but mostly idiopathic (30-70%) before the era of TRUS & MRI, which eventually related with a benign, self-limiting course of disease. There are 2 major categories of hemospermia consisting of isolated hemospermia with idiopathic self-limited character, and hemospermia with associated conditions including inflammation and infection, ductal obstructions due to cyst, calculi, calcification, tumor, vascular abnormalities, systemic diseases and iatrogenic. Most common associated condition is inflammatory or infectious processes. According to age of the patient, behavior-related or infectious condition is common on younger than 40 years comparing to neoplasia or structural abnormalities on older than 40 years. In aspect of duration of symptoms, first or few episodes are related with identifiable etiology like urogeniatlal infection or intense sexual experiences, but persistent or recurrent, high-volume hemospermia indicates a pathologic condition like vascular abnormalities, tumors or bleeding diathesis. Of associated condition and underlying pathology, concern about underlying malignancy is mandatory. As reference investigations for this evidence, Leary et al. (1974) showed 4% prostatic cancer and 1% bladder cancer among 150 cases with hemospermia during 5-23 years follow-up and Han et al. (2004) reported 14% prostatic cancer among 0.5% hematospermia in 26,126 screening. Diagnostic tools are also variable from symptoms and signs, detailed history, physical examination, laboratory test to imaging studies or endoscopic evaluation.
Therapeutic options are also variable including conservative vs. radical, medical vs. surgical which are watchful waiting and reassurance, medical management with antibiotics, NSAIDs, anticoagulant and α-blocker, hormonal therapy with 5α-reductase inhibitors, chemotherapy, radiotherapy as well as surgical management with aspiration under TRUS, transurethral resection of ejaculatory duct, ureteroscopic fenestration and laparoscopic/open excision.
Even though there are many options for patient with hemospermia, therapeutic strategy would be directed to diagnosed etiology.
