Hematospermia Etiology, Diagnosis, Treatment, and Sexual Ramifications: A Narrative Review

Sexual Medicine Reviews - Tập 10 - Trang 669-680 - 2022
Robert H. Drury1, Brendan King1, Bryan Herzog1, Wayne J.G. Hellstrom1
1Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA

Tóm tắt

AbstractIntroductionHematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare condition that is historically idiopathic or associated with sexual behavior. Technological advances have identified many of the etiologies behind HS, improving treatment. Though often benign, HS remains a source of considerable sexual anxiety for patients. Few papers have outlined a diagnostic and therapeutic approach to HS, and none have explicitly addressed its sexual consequences.ObjectivesTo provide a comprehensive overview of HS, emphasizing its sexual ramifications.MethodsA PubMed literature search was performed through May 2021 to identify all relevant publications related to etiology, diagnosis, treatment, and sexual effects of HS. Original research and reviews were analyzed, and pertinent studies were included in this review.ResultsIatrogenic interventions (eg, transrectal ultrasound-guided prostate biopsies) are the most common cause of HS. Infection and/or nonspecific inflammation is the most common non-iatrogenic etiology. Malignancies, including prostate, testicular, and other genitourinary cancers, are rarely the cause of HS. Diagnostic approaches to HS can be organized according to patient age (less than or greater than 40 years old), persistence of bleeding, and the presence/absence of concerning symptoms. Though HS often spontaneously resolves, treatment may require various medications (eg, antibiotics, anti-inflammatories) or surgical interventions. HS has several sexual ramifications, including libido-affecting anxiety, social repercussions from sexual partners and non-sexual affiliates, increased risk of erectile dysfunction or transmission of sexual infections, and compromised fertility, especially when cryopreservation is utilized.ConclusionHS may significantly affect sexual health through several mechanisms, though there is a paucity of formal data on this subject. Further research is needed to fully understand the severity and extent of HS's effect on sexual well-being, especially in those with refractory bleeding.

Tài liệu tham khảo

Polito, 2006, Hematospermia: diagnosis and treatment, Arch Ital Urol Androl, 78, 82 Efesoy, 2020, Hematospermia is rarely related to genitourinary cancer: lessons learned from 15 years of experience with 342 cases, Int J Impot Res, 10.1038/s41443-020-0330-9. E-pub ahead of print Sivanandan, 2019, A prospective study on aetiology and outcome of haemospermia from a urology unit in Sri Lanka, Journal of Clinical Urology, 12, 280, 10.1177/2051415819836021 Zhao, 2012, The value of transrectal ultrasound in the diagnosis of hematospermia in a large cohort of patients, J Androl, 33, 897, 10.2164/jandrol.111.013318 Wilson, 2010, A single episode of haematospermia can be safely managed in the community, Int J Clin Pract, 64, 1436, 10.1111/j.1742-1241.2009.02242.x Huang, 2020, Clinical characteristics and endoscopic treatment of hematospermia with postcoital hematuria, BMC Urol, 20, 78, 10.1186/s12894-020-00646-x Yu, 1977, Clinical study of hemospermia, Urology, 10, 562, 10.1016/0090-4295(77)90102-9 Leary, 1974, Clinical significance of hemato-spermia, Mayo Clin Proc, 49, 815 Mulhall, 1995, Hemospermia: diagnosis and management, Urology, 46, 463, 10.1016/S0090-4295(99)80256-8 Ahmad, 2007, J Urol, 177, 1613, 10.1016/j.juro.2007.01.004 Torigian, 2007, Hematospermia: imaging findings, Abdom Imaging, 32, 29, 10.1007/s00261-006-9013-3 Ng, 2013, Haematospermia as a presenting symptom: outcomes of investigation in 300 men, Surgeon, 11, 35, 10.1016/j.surge.2012.04.004 Oh, 2016, Endoscopic Treatment for Persistent Hematospermia: A Novel Technique Using a Holmium Laser, Scand J Surg, 105, 174, 10.1177/1457496915613647 Xing, 2012, Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia, Int J Urol, 19, 437, 10.1111/j.1442-2042.2011.02952.x Han, 2004, Association of hemospermia with prostate cancer, J Urol, 172, 2189, 10.1097/01.ju.0000144565.76243.b1 Mittal, 2016, Hematospermia Evaluation at MR Imaging, Radiographics, 36, 1373, 10.1148/rg.2016150195 Akhter, 2013, Should every patient with hematospermia be investigated? A critical review, Cent European J Urol, 66, 79, 10.5173/ceju.2013.01.art25 Leocádio, 2009, Hematospermia: etiological and management considerations, Int Urol Nephrol, 41, 77, 10.1007/s11255-008-9409-9 Mathers, 2017, Hematospermia-a Symptom With Many Possible Causes, Dtsch Arztebl Int, 114, 186 Abdelkhalek, 2013, Hemosepermia after transrectal ultrasound-guided prostatic biopsy: A prospective study, Urol Ann, 5, 30, 10.4103/0974-7796.106963 Manoharan, 2007, Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study, Prostate Cancer Prostatic Dis, 10, 283, 10.1038/sj.pcan.4500955 Raaijmakers, 2002, Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program, Urology, 60, 826, 10.1016/S0090-4295(02)01958-1 Kakehi, 2008, Japanese Urological Association. Complication rates of ultrasound-guided prostate biopsy: a nation-wide survey in Japan, Int J Urol, 15, 319, 10.1111/j.1442-2042.2008.02048.x Baert, 1983, Treatment of chronic bacterial prostatitis by local injection of antibiotics into prostate, Urology, 21, 370, 10.1016/0090-4295(83)90154-1 Bihrle, 1994, High intensity focused ultrasound for the treatment of benign prostatic hyperplasia: early United States clinical experience, J Urol, 151, 1271, 10.1016/S0022-5347(17)35230-8 Finney, 2005, Cross-sectional analysis of sexual function after prostate brachytherapy, Urology, 66, 377, 10.1016/j.urology.2005.03.045 Merrick, 2001, Short-term sexual function after prostate brachytherapy, Int J Cancer, 96, 313, 10.1002/ijc.1028 Suh, 2017, Etiologic classification, evaluation, and management of hematospermia, Transl Androl Urol, 6, 959, 10.21037/tau.2017.06.01 Bamberger, 2005, Detection of sexually transmitted pathogens in patients with hematospermia, Isr Med Assoc J, 7, 224 Koment, 1983, Infection by human cytomegalovirus associated with chronic hematospermia, Urology, 22, 617, 10.1016/0090-4295(83)90309-6 Schwartz, 2002, Hematospermia due to schistosome infection in travelers: diagnostic and treatment challenges, Clin Infect Dis, 35, 1420, 10.1086/344063 Musso, 2015, Potential sexual transmission of Zika virus [published correction appears in Emerg Infect Dis. 2015 Mar;21(3):552], Emerg Infect Dis, 21, 359, 10.3201/eid2102.141363 Lang, 2017, Hematospermia in a returned traveler, Can Urol Assoc J, 11, E41, 10.5489/cuaj.3836 Jinza, 1997, [Retrospective study of 107 patients with hematospermia.], Hinyokika Kiyo, 43, 103 Zargooshi, 2014, Hemospermia: long-term outcome in 165 patients, Int J Impot Res, 26, 83, 10.1038/ijir.2013.40 Fletcher, 1981, The aetiology and investigation of haemospermia, Br J Urol, 53, 669, 10.1111/j.1464-410X.1981.tb03287.x Madhushankha, 2021, Clinical characteristics, etiology, management and outcome of hematospermia: a systematic review, Am J Clin Exp Urol, 9, 1 Expert Panel on Urologic Imaging, 2017, ACR Appropriateness Criteria® Hematospermia, J Am Coll Radiol, 14, S154 Amasanti, 2017, Hematospermia as a manifestation of severe hypertension in a young man, Clin Case Rep, 5, 446, 10.1002/ccr3.849 Narouz, 2002, Haematospermia: in the context of a genitourinary medicine setting, Int J STD AIDS, 13, 517, 10.1258/095646202760159620 Khodamoradi, 2020, Laboratory and clinical management of leukocytospermia and hematospermia: a review, Ther Adv Reprod Health, 14 Maheshkumar, 2001, Testicular tumor presenting as hematospermia, J Urol, 165, 188, 10.1097/00005392-200101000-00050 Yagci, 2004, Efficacy of transrectal ultrasonography in the evaluation of hematospermia, Clin Imaging, 28, 286, 10.1016/S0899-7071(03)00157-8 Chen, 2018, Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases, Asian J Androl, 20, 438, 10.4103/aja.aja_76_17 Liao, 2019, Etiology of 305 cases of refractory hematospermia and therapeutic options by emerging endoscopic technology, Sci Rep, 9, 5018, 10.1038/s41598-019-41123-2 Li, 2013, Clinical analysis of the characterization of magnetic resonance imaging in 102 cases of refractory haematospermia, Andrology, 1, 948, 10.1111/j.2047-2927.2013.00132.x Furuya, 2008, Magnetic resonance imaging is accurate to detect bleeding in the seminal vesicles in patients with hemospermia, Urology, 72, 838, 10.1016/j.urology.2008.05.058 Furuya, 1999, Hematospermia: an investigation of the bleeding site and underlying lesions, Int J Urol, 6, 539, 10.1046/j.1442-2042.1999.611110.x McGuinness, 2017, Magnetic resonance imaging in hematospermia: does it increase unnecessary prostate biopsy?, Curr Urol, 10, 50, 10.1159/000447151 Furuya, 2016, Natural history of hematospermia in 189 Japanese men, Int J Urol, 23, 934, 10.1111/iju.13176 Ganabathi, 1992, Haemospermia, Br J Urol, 69, 225, 10.1111/j.1464-410X.1992.tb15517.x Li, 2012, Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia, J Androl, 33, 906, 10.2164/jandrol.111.015487 Badawy, 2012, Finasteride for treatment of refractory hemospermia: prospective placebo-controlled study, Int Urol Nephrol, 44, 371, 10.1007/s11255-011-0057-0 Yang, 2002, Transutricular seminal vesiculoscopy, J Endourol, 16, 343, 10.1089/089277902760261347 Wang, 2020, Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study, Asian J Androl, 22, 507, 10.4103/aja.aja_134_19 Liu, 2009, Transurethral seminal vesiculoscopy in the diagnosis and treatment of persistent or recurrent hemospermia: a single-institution experience, Asian J Androl, 11, 566, 10.1038/aja.2009.47 Han, 2009, Transutricular seminal vesiculoscopy in hematospermia: technical considerations and outcomes, Urology, 73, 1377, 10.1016/j.urology.2008.07.038 Wang, 2021, Transrectal ultrasound-guided seminal vesicle catheterization with continuous antibiotic infusion for the treatment of refractory hematospermia, Exp Ther Med, 21, 32 Manohar, 2008, Transrectal ultrasound- and fluoroscopic-assisted transurethral incision of ejaculatory ducts: a problem-solving approach to nonmalignant hematospermia due to ejaculatory duct obstruction, J Endourol, 22, 1531, 10.1089/end.2007.0415 Wu, 2016, Clinical outcome of treating intractable hematospermia using holmium laser incision through a ureteroscope, Asian J Androl, 18, 140, 10.4103/1008-682X.151392 Wang, 2006, Arterial bleeding in patients with intractable hematospermia and concomitant hematuria: a preliminary report, Urology, 68, 938, 10.1016/j.urology.2006.06.015 de León, 2008, Hemangioma of the prostatic urethra: holmium laser treatment, Urol Int, 80, 108, 10.1159/000111741 Rajkumar, 2015, Depression and anxiety in men with sexual dysfunction: a retrospective study, Compr Psychiatry, 60, 114, 10.1016/j.comppsych.2015.03.001 Déziel, 2018, Anxiety, dispositional mindfulness, and sexual desire in men consulting in clinical sexology: a mediational model, J Sex Marital Ther, 44, 513, 10.1080/0092623X.2017.1405308 Bozman, 1991, Covariation of sexual desire and sexual arousal: the effects of anger and anxiety, Arch Sex Behav, 20, 47, 10.1007/BF01543007 Lu, 2020, The decline in sexual function, psychological disorders (anxiety and depression) and life satisfaction in older men: A cross-sectional study in a hospital-based population, Andrologia, 52, e13559, 10.1111/and.13559 Dell'Atti, 2017, Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy, Int Braz J Urol, 43, 1136, 10.1590/s1677-5538.ibju.2016.0005 Lü, 2016, [Ejaculatory duct dilation combined with seminal vesicle clysis for refractory hematospermia: A report of 32 cases], Zhonghua Nan Ke Xue, 22, 511 Ambakederemo, 2015, Bloody semen, severe hypertension and a worried man, Pan Afr Med J, 20, 326, 10.11604/pamj.2015.20.326.6194 Magri, 2008, Chronic prostatitis and erectile dysfunction: results from a cross-sectional study, Arch Ital Urol Androl, 80, 172 Muranaka, 2014, Urethral polyp-like lesions on prostatic urethra caused by Chlamydia trachomatis infection: a case report, J Infect Chemother, 20, 726, 10.1016/j.jiac.2014.07.002 Foy, 2011, Probable non-vector-borne transmission of Zika virus, Colorado, USA, Emerg Infect Dis, 17, 880, 10.3201/eid1705.101939 Huits, 2017, Zika virus in semen: a prospective cohort study of symptomatic travellers returning to Belgium, Bull World Health Organ, 95, 802, 10.2471/BLT.17.181370 Payne, 2020, Twenty-first century viral pandemics: a literature review of sexual transmission and fertility implications in men, Sex Med Rev, 8, 518, 10.1016/j.sxmr.2020.06.003 Torresi, 1997, Usefulness of semen microscopy in the diagnosis of a difficult case of schistosoma haematobium infection in a returned traveler, J Travel Med, 4, 46, 10.1111/j.1708-8305.1997.tb00774.x Colpi, 1988, Seminal tract inflammation and male infertility. Correlations between leukospermia and clinical history, prostatic cytology, conventional semen parameters, sperm viability and seminal plasma protein composition, Acta Eur Fertil, 19, 69 Brunner, 2019, Review of guidelines for the evaluation and treatment of leukocytospermia in male infertility, World J Mens Health, 37, 128, 10.5534/wjmh.180078 Kurscheidt, 2018, Effects of herpes simplex virus infections on seminal parameters in male partners of infertile couples, Urology, 113, 52, 10.1016/j.urology.2017.11.050 Adamopoulos, 1996, Seminal volume and total sperm number trends in men attending subfertility clinics in the greater Athens area during the period 1977-1993, Hum Reprod, 11, 1936, 10.1093/oxfordjournals.humrep.a019520 Khan, 2012, Seminal volume in the investigation of male infertility, J Coll Physicians Surg Pak, 22, 159 Weintraub, 1993, Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction, J Urol, 150, 1150, 10.1016/S0022-5347(17)35711-7 Kardoust Parizi, 2013, Management of zinner’s syndrome associated with contralateral seminal vesicle hypoplasia: a case report, Case Rep Urol, 2013 Florim, 2018, Zinner syndrome presenting with intermittent scrotal pain in a young man, Radiol Case Rep, 13, 1224, 10.1016/j.radcr.2018.08.012 Sherman, 1973, Synopsis of the use of frozen human semen since 1964: state of the art of human semen banking, Fertil Steril, 24, 397, 10.1016/S0015-0282(16)39678-9 Sanger, 1992, Semen cryobanking for men with cancer–criteria change, Fertil Steril, 58, 1024, 10.1016/S0015-0282(16)55454-5 Di Santo, 2012, Human sperm cryopreservation: update on techniques, effect on DNA integrity, and implications for ART, Adv Urol, 2012, 10.1155/2012/854837 Watson, 2000, The causes of reduced fertility with cryopreserved semen, Anim Reprod Sci, 60-61, 481, 10.1016/S0378-4320(00)00099-3 Rijsselaere, 2004, Effect of blood admixture on in vitro survival of chilled and frozen-thawed canine spermatozoa, Theriogenology, 61, 1589, 10.1016/j.theriogenology.2003.09.008 Zapora, 2013, Hemoglobina–źródłem reaktywnych form tlenu [Hemoglobin–source of reactive oxygen species], Postepy Hig Med Dosw (Online), 67, 214, 10.5604/17322693.1043334 Phillips, 2012, Efficacy of four density gradient separation media to remove erythrocytes and nonviable sperm from canine semen, Theriogenology, 77, 39, 10.1016/j.theriogenology.2011.07.012 Son, 2015, Non-motile sperm cell separation using a spiral channel, Anal Methods, 7, 8041, 10.1039/C5AY02205C Girolami, 2009, Hemospermia in patients with congenital coagulation disorders: a study of three cases, Acta Haematol, 121, 42, 10.1159/000210063