Background: Hematospermia, although often found to be a benign condition, can be an alarming sign. Consequently, patients can undergo multiple investigations with no current standardized pathway based on data from large series. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia. Materials and methods: A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center. Patient demographics, radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes. Results: In this cohort, the overall prostate cancer detection rate was 5.3% and 7.2% in the ≥40 years group. One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy. In addition, 5.6% of patients were found to have a significant benign pathology for which intervention was proposed. A total of 288 patients underwent a transrectal ultrasound scan and 58.7% (n = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% (n = 81) had a positive finding. Conclusions: Apart from transrectal ultrasound and multiparametric magnetic resonance imaging, the remaining investigations have a low diagnostic yield. Prostate cancer detection was 5.3%; 7.2% in the ≥40 years group, and two further patients were diagnosed with testicular and bladder malignancy. Based on our results, we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.
LithoVue outperformed the PU3022 in visibility rating, p¼0.003. There was also a significant difference in the maneuverability (out of 5) of the ureterorenoscopes, p<0.001. Both the URF-V2 (4.8, 95% CI 4.7-5) and LithoVue (4.7, 95% CI 4.5-4.8) outperformed the PU3022 (4.2, 95% CI 4.0-4.3), p¼0.001 and p<0.001 respectively. There was no difference between the URF-V2 and LithoVue, p¼0.27. There was no difference in the clearance rate of renal calculi, 86% (LithoVue), 87% (Olympus), 93% (Pusen), p¼0.2. Scope failures occurred in 1 LithoVue (deflection control mechanism broke), 2 Olympus URF-V2 (Deflection mechanism did not work and tension wire for deflection mechanism broke) and 2 Pusen PU3022 (image failed to load onto machine). One benefit noted with the Pusen PU3022 scope over the LithoVue was the lack of screen lag.CONCLUSIONS: Our study is the first to directly compare two different single use, digital flexible ureterorenoscopes. Our study shows that the performance of single use ureterorenoscopes is approaching that of the reusable video, ureterorenoscopes. In the era of multiresistant organisms and increasing concern over current sterilizing techniques for fragile ureterorenoscopes, the single use ureterorenoscopes are an increasingly feasible alternative to traditional, expensive, reusable ureterorenoscopes.Source of Funding: Five Boston Scientific LithoVue and five Pusen PU3022 ureterorenoscopes were provided by their respective companies for this study.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.