Clinical features of haematospermia associated with seminal vesicle calculi versus posterior urethral haemangioma

Abstract

To compare the clinical features of seminal vesicle calculi(SVC) versus posterior urethral haemangioma(PUH) to assist urologists in differentiating and diagnosing the causes of haematospermia. Patients with SVC or PUH were included. Patient age, disease duration, hospital stay, operation time, symptoms, surgical approach, pathological results and postoperative complications were recorded. A total of seven patients with SVC and 15 patients with PUH involved have an average age of 34.1 and 44.5 years separately. Patients with SVC complained of recurrent haematospermia; patients with PUH complained of recurrent haematospermia and urethral opening bleeding after sexual arousal. SVC manifested as a dark red blood-semen mixture with ejaculation pain and no blood clots; the condition could improve after anti-infective treatment. PUH manifested as no visible blood-semen mixture, bright red semen with blood clots and no ejaculation pain; the condition did not respond to anti-infective treatment. SVC was treated with holmium laser lithotripsy under a transurethral seminal vesiculoscopy. PUH was treated with transurethral resection and fulguration. Postoperative follow-up showed that the clinical symptoms gradually disappeared, with no postoperative complications. Both SVC and PUH can result in recurrent haematospermia. Therefore, urologists should treat haematospermia differently according to the cause.

Successful treatment of seminal vesicle calculi and prostatic utricle calculi by transurethral seminal vesiculoscopy

“…The clinical manifestations of SVC and PUC are intractable or persistent haematospermia, which are not relieved with active anti‐inflammatory treatment. Patients can have multiple recurrences of SVC and PUC, and the majority of patients present with painful ejaculation (Liao et al, 2019; Tian et al, 2018; Zaidi et al, 2019). Patients with SVC also complained of lower abdominal pain, perineal discomfort or pain, and/or infertility (Miao et al, 2020; Li, 1991).…”

“…The aetiology of SVC is unclear, with limited literature, mostly in the form of case reports (Miao et al, 2020; Zaidi et al, 2019). With the development of imaging technologies and the introduction of transurethral seminal vesiculoscopy (TSV), an increasing number of patients with SVC are being diagnosed and treated successfully by clinicians (Yang, Rha, Byon,& Kim, 2002; Tian, Han, Lei, & Zhang, 2018).…”

Guiding role of seminal tract anatomical study in transurethral seminal vesiculoscopy.

“…Our department used TSV to treat 48 patients from January 2013 to July 2016, performed by 3 surgeons. They were not able to locate the ejaculatory duct opening in some cases, which led to surgical failures; in addition, we have identified other complications, such as epididymitis, urinary tract infection (UTI), ejaculation abnormality (EA), continuous hematuria (CH) and clinical symptoms of rectal injury [11]. The main reason that the low qualification operator training system results in errors is an emphasis on surgical techniques while neglecting the anatomy and holistic view of the seminal tract.…”

Etiology, Diagnosis, and Management of Seminal Vesicle Stones

“…Ejaculatory pain and hematospermia are the two most common symptoms that lead patients to seek medical care. SV stones can be distinguished from a condition such as posterior urethral hemangioma as it uniquely presents with dark red blood-semen mixture with ejaculation pain and no blood clots - symptoms which withdraw upon anti-infective treatment [24]. Table 2 displays the diverse profiles of some symptoms occurring in patients associated with SV calculi.…”