Hematospermia Evaluation at MR Imaging

Abstract

Hematospermia is a challenging and anxiety-provoking condition that can manifest as a single episode or recur over the course of weeks to months. It is usually a benign self-limiting condition in younger sexually active males without a history of risk factors such as cancer, urogenital malformations, bleeding disorders, and their associated symptoms. However, patients with recurrent, refractory and painful hematospermia with associated symptoms, such as fever, pain, or weight loss, require evaluation through clinical assessment and noninvasive investigations to rule out underlying pathologic conditions such as ejaculatory obstruction, infectious and inflammatory causes, malignancy, vascular malformations, and systemic disorders that increase the risk of bleeding, especially when presenting in older men. If these investigations are negative, the patient should be reassured and treated accordingly. In the recent past, magnetic resonance (MR) imaging has assumed a major role in the investigation of hematospermia due to its excellent soft-tissue contrast and multiplanar capabilities. In this review, we will discuss the potential causes of hematospermia and its diagnostic workup, including pathophysiology, anatomic considerations, the imaging appearance of associated pathologic conditions, and management. (©)RSNA, 2016.

Transurethral resection of ejaculatory duct combined with seminal vesiculoscopy for management of persistent or recurrent hemospermia in men with ejaculatory duct obstruction

“…Haematospermia, or haemospermia, is usually regarded as a benign and self-limiting symptom, requiring no additional treatment or evaluation [19,20]. However, the condition is often associated with impaired quality of life owing to induced anxiety and must be taken seriously by both patients and physicians, particularly if it is recurrent and refractory and has co-existing pain [1,2].…”

Hematospermia as a manifestation of severe hypertension in a young man

“…Hematospermia is almost always a benign and transient phenomenon . It is most commonly a sequelae of infection, such as prostatitis, urethritis, epididymo‐orchitis; medical intervention, such as a prostate biopsy; or trauma, such as a perineal injury.…”

Congenital and hereditary cystic diseases of the abdomen

“…On the contrary, Mullerian duct cysts are not expected to associate with any congenital genitourinary malformations. Both cysts may manifest with various symptoms, including difficulty urinating, dysuria, ejaculatory impairment, and hematospermia [31,69]. In these cystic lesions, the mechanism of hematospermia is considered to be due to ejaculatory duct obstruction [68].…”

“…In terms of size, prostatic utricle cysts are typically smaller than Mullerian duct cysts. From an anatomical standpoint, prostatic utricle cysts communicate with the prostatic urethra unlike Mullerian duct cyst [31,68,69]. Voiding cystourethrography may help differential diagnosis by demonstrating the connection between the prostatic utricle cyst and the urethra [70] (Fig.…”