Presentation Authors: Ozan Efesoy, Selahittin Çayan*, Mersin, Turkey, Ramazan Aşcı, Samsun, Turkey, İrfan Orhan, Elazığ, Turkey, Önder Yaman, Ankara, Turkey
Introduction: To investigate the underlying causes and frequency of cancer in patients with hematospermia.
Methods: During a 15 years period, medical records of 161.258 men with >18 years old, presenting to Urology clinics, were screened retrospectively for the presence of hematospermia. Patients with external or iatrogenic trauma and genitourinary cancer history were excluded from the study. The study included 342 men who presented for hematospermia. Demographic data, history and physical examination results, all diagnostic tests, applied treatment, and follow-up information were recorded and evaluated in all patients.
Results: Hematospermia was detected in 342 (0.21%) of the 161258 urological patients. The mean age of the patients was 45.05Â±14.04 years (range: 16 to 85), and the median duration of hematospermia was 15 days (range 1 to 7200). Isolated hematospermia was found in 169 of 342 patients (49.4%). The remaining 173 patients (50.6%) were found to have one or more additional symptoms. Common additional symptoms consisted of lower urinary tract symptoms, dysuria, pelvic/perineal pain, painful ejaculation, and testicular pain. The etiologic causes of hematospermia were inflammation/infections in 169 (49.4%), idiopathic in 96 (28.1%), ductal obstruction and cysts in 34 (9.9%), systemic factors in 32 (9.4%), and genitourinary cancers were detected in only 11 patients (3.2%) as prostate cancer in 8 and testicular cancer in 3. On TRUS, 71.2% had visible one or more pathology that might be responsible for hematospermia. Of the patients, 306 (89.5)% had complete cure after medical therapy due to infections/inflammations, surgery due to ductal obstruction and cysts, prostate and testicular cancer. However, 36 (10.5%) had persistent/recurrent hematospermia. Mean serum t/fPSA level was found as 11.88Â±14.88/1.74Â±0.95 ng/ml in the patients who were diagnosed prostate cancer with total PSA level of >4 ng/ml, except one. All of the patients who were diagnosed testicular cancer had testicular pain and/or swelling.
Conclusions: Hematospermia is seen frequently due to inflammatory or infectious causes, and is rarely associated with genitourinary cancer. Further diagnostic evaluation of hematospermia is not necessary in most patients. However, further diagnostic tools might be necessary to exclude urogenital malignancy in patients with specific findings of history and/or physical examination, non-response to empirical treatment, family history of testicular and/or prostate cancer, and associated symptoms such as lower urinary tract symptoms and scrotal pain and/or swelling.