ESSM Newsletter # 40

14 ESSM Today The problem of hemospermia is known to doc- tors since ancient times, and its first descriptions belong to Hippocrates and Galen. Up to 77% of men go to the urologist after the first or second episode of the appearance of hemospermia. At the same time, in 70–80% of cases the cause of hemospermia is not detected and the spontaneous resolution of this disease is noted in 60% of cases within a month. The concept of hemospermia refers to the pres- ence of blood in the semen, which is caused by both anatomical and functional disorders of the male sex glands, urethra, or vas deferens. It is necessary to distinguish between true he- mospermia (haemospermia vera), in which blood evenly paints sperm in a rusty or chocolate color, as well as false hemospermia (haemospermia spuria), in which blood is mixed with sperm in the form of individual filamentous clots. It should be noted that hemospermia occurs in men of all ages, usually from 30 to 40 years, with an average age of 37 years, and the pres- ence of hemospermia lasts, as a rule, from one month to two years. Nevertheless, today it is known that in most cases the appearance of hemospermia is not dangerous for men, but requires a comprehen- sive study, and follow-up by a doctor. The only exceptions are persons over 50 years old with suspected prostate cancer (PCa), since the ap- pearance of hemospermia is associated with an increased risk of developing prostate cancer in men over 50 years old. If we are talking about the causes of hemos- permia, so in a separate category should be distinguished congenital causes, which include cysts of the seminal vesicles and ejaculatory tract. The group of inflammatory diseases in- cludes urethritis, prostatitis, epididymitis, ve- siculitis, condylomas of the urethra, tuberculosis, schistosomiasis and viral lesions. Also, obstruc- tion due to post-inflammatory changes, as well as calculus, diverticula and cysts of the seminal vesicles and stricture of the urethra can also cause hemospermia. Malignant diseases should be considered: Neoplasms of the prostate gland, bladder, seminal vesicles and scrotum organs. The category of vascular factors is represented by varicose veins, hemangiomas, and sexual excesses. Traumatic causes are direct injuries, as well as the consequences of minimally invasive treatment of hemorrhoids and iatrogenic (for example, after a prostate biopsy). Also, systemic diseases may be present, such as hypertension, hemostasis pathology and taking certain medi- cations. In many publications, von Willebrand syndrome and coagulopathy are mentioned (especially in patients with impaired liver func- tion). Of course, you should always find out if the patient is receiving anticoagulant therapy (for example, aspirin or heparin). What is the diagnostic algorithm for identifying the cause of hemospermia? So, the presence of hemospermia should always involve a complex urological examination. In all patients complain- ing about blood admixture in semen, attention should be paid to concomitant symptoms, such as pain, lower urinary tract symptoms, and it is also important to assess the likelihood of having sexually transmitted infections (epidemiological and sexual history), pay attention to blood pres- sure and the state of the blood coagulation sys- tem. We study in detail the history of the develop- ment of the disease, the presence of concomitant diseases, which drugs the patient has taken or is currently taking. It is important to consider the family history of the patient (especially in relation to prostate cancer), paying attention to first-degree relatives or relatives diagnosed before the age of 60, as well as coagulopathy. Next, we resort to the integrated use of labora- tory and instrumental methods of research. It is important to distinguish hemospermia from hematuria. Thus, the performance of a general urine analysis and its culture can reveal the pres- ence of urinary system infection and hematuria. In the case of detection of non-infectious leuko- cyturia, it is necessary to exclude tuberculosis of the urogenital system and associated diseases. In the presence of leukospermia per the results of sperm analysis, it is necessary to carry out a culture study of the ejaculate, a smear from the urethra, mycobacterial culture and serological testing for the presence of viruses. Performing a clinical (general) blood test, coagulogram, reveals hidden blood diseases. In addition, recent urologic studies or interven- tions, the presence of episodes of prolonged bleeding or light bruising from minor injuries or surgical interventions, trips to regions where tuberculosis and schistosomiasis are endemic should be considered. During physical examination of the patient it is recommended to examine the external genital organs, palpate the scrotum for the presence of swelling, elasticity, tuberosity of the testes and appendages, as well as a digital rectal ex- amination to evaluate the prostate for enlarge- ment, elasticity, mobility and nodules. It is also recommended to look for signs of light bruising Hemospermia. What you need to know man by Oleg Apolikhin, E. A. Efremov and Yu. V. Kastrikin Apolikhin O.I., MD, PhD Chief specialist of the Ministry of health care of Russia in Reproductive Health, Director N. Lopatkin Scientific Research Institute of Urology, Russia apolikhin.oleg@yahoo.com Efremov Е. А. Dr. M.Sc., Professor of the Department of Urology, Andrology and Oncourology Pirogov Russian National Research Medical University, Russia konfandrology@rambler.ru Kastrikin Yu. V. Researcher associate of the Department of Andrology and Human Reproductive Health of Research Institute of Urology and Interventional Radiology N.A. Lopatkin, Russia yurii_kn@mail.ru