HEMOSPERMIA
D. A. TOLLEY, J. E. CASTRO,
M.B., M.S.,
From the Urology Royal Postgraduate London, England
F.R.C.S. F.R.C.S.
and Transplant Unit, Medical School,
ABSTRACT -A study of 26 patients with primary hemospermia has been made. When primary hemospermia was the only symptom, urologic investigation was normal. It appears that such patients do not require detailed investigation whereas those presenting with hemospermia and other urologic symptoms require further investigations appropriate to those symptoms.
24 of the patients were seen within two months of the initial symptom. Six patients had hemospermia on one occasion only, and 20 had recurrent episodes, usually occurring over a short interval of time and then abating. Twenty-four patients had coitus; in 11 this occurred more than twice each week, in 9 it was less than once each month. Occasional masturbation was the only sexual activity in 2 patients. Only 1 patient reported more frequent coitus at the time of hemospermia, and in 1 patient it was less frequent. In 18 patients hemospermia was the only symptom. Ofthe remaining 8 patients, 4 had hematuria which occurred after coitus at the time of hemospermia; in 3, 2 had dysuria, 1 had hesitancy, and 1 the symptom complex of urinary outflow obstruction. Two patients also gave a history of trauma near the time of hemospermia: 1 was kicked in the perineum, and the other was sprayed in the groins with a compressed air gun. One patient was a known hemophiliac. Abnormal clinical findings were present in 6 patients. Three patients were asymptomatic: 1 had a small hemangioma on the glans penis, and 2 had small hydroceles. In the remaining 3 patients there were signs commensurate with symptoms: 1 had outflow tract obstruction and, on rectal examination, benign enlargement (30 Gm.) of the prostate; 2 complained of dysuria and in each a tender prostate was noted on examination. All patients were normotensive. In all 26 patients urine specimens were normal on microscopic examination and bacteriologic
Hemospermia implies the presence of blood in the ejaculate. Occasionally, the symptom may be associated with hypertension, prostatitis, genitourinary tuberculosis, or carcinoma of either the prostate or seminal vesicles. The exact significance of the condition is not clear, and we have therefore studied a group of patients whose primary complaint was hemospermia. Material
and Methods
Twenty-six patients with hemospermia as a primary complaint were seen in the period from 1969 to 1974. Twenty-three were Caucasian born in the United Kingdom, 2 were West Indian, and 1 Guyanan. Ages ranged from eighteen to sixtythree years (mean thirty-nine years). Fourteen were married. A full history (including sexual history) and clinical examination were made. A full blood count, including platelets, was done, and biochemical screening with measurements of serum acid phosphatase was undertaken in some patients. Urine specimens were obtained for microscopic examination and bacteriologic culture, and three early morning specimens were examined for tuberculosis. Excretion urogram and diagnostic panendoscopy were performed. Results The interval between the first episode of hemospermia and request for medical advice varied between seven days and eighteen months, but
UROLOGY
/ SEJTEMBER
1975 / VOLUME
VI, NUMBER
3
331
culture. In none of 18 patients examined were acid-fast bacilli found in the urine. Hematologic findings and biochemical profile were normal in all 23 patients examined, and the serum acid phosphatase was normal in 12 patients in whom it was measured. Twenty-four patients had excretion urography; signs of outflow tract obstruction were seen in 1 patient, and the remainder were normal. Panendoscopy was performed in 20 patients, and in 2 the results were abnormal. The presence of outflow tract obstruction was confirmed in the patient with an abnormal pyelogram, and another patient was judged to have clinically significant median lobe enlargement treated by transurethral resection. Comment Primary hemospermia is not a rare condition, 26 cases being seen at our clinic over the past five years. However, there is little guide from the literature on the significance of this symptom and particularly how far it needs to be investigated. A search of the literature for the past ten years revealed no studies of hemospermia. It would appear that patients with hemospermia fall naturally into two groups. The first are
332
those patients with hemospermia as their only urologic symptom, who, on clinical examination, are normal. In these patients there is no obvious precipitating cause, and more particularly our results suggest that changes in sexual activity play no part in its causation. Eighteen of our patients were in this group, and further detailed urologic examination was normal in all. In the second group, there is either an obvious precipitating cause, or on direct questioning, patients admit to other urologic symptoms. Eight of our patients were in this group: 4 had an obvious clinical cause for hemospermia (trauma, hemophilia, hemangioma of the glans penis), and of the remaining 4 with other urologic symptoms, abnormal clinical findings were noted in 2. These results suggest that patients with primary hemospermia as the only symptom need no further investigation, whereas, those with hemospermia and other urologic symptoms require further investigation. Hammersmith Hospital Du Cane Road London W12 OHS, England (DR. CASTRO)
UROLOGY
/ SEPTEMBER1975
/ VOLUMEVI,
NUMBER3
D. A. TOLLEY, J. E. CASTRO,
M.B., M.S.,
From the Urology Royal Postgraduate London, England
F.R.C.S. F.R.C.S.
and Transplant Unit, Medical School,
ABSTRACT -A study of 26 patients with primary hemospermia has been made. When primary hemospermia was the only symptom, urologic investigation was normal. It appears that such patients do not require detailed investigation whereas those presenting with hemospermia and other urologic symptoms require further investigations appropriate to those symptoms.
24 of the patients were seen within two months of the initial symptom. Six patients had hemospermia on one occasion only, and 20 had recurrent episodes, usually occurring over a short interval of time and then abating. Twenty-four patients had coitus; in 11 this occurred more than twice each week, in 9 it was less than once each month. Occasional masturbation was the only sexual activity in 2 patients. Only 1 patient reported more frequent coitus at the time of hemospermia, and in 1 patient it was less frequent. In 18 patients hemospermia was the only symptom. Ofthe remaining 8 patients, 4 had hematuria which occurred after coitus at the time of hemospermia; in 3, 2 had dysuria, 1 had hesitancy, and 1 the symptom complex of urinary outflow obstruction. Two patients also gave a history of trauma near the time of hemospermia: 1 was kicked in the perineum, and the other was sprayed in the groins with a compressed air gun. One patient was a known hemophiliac. Abnormal clinical findings were present in 6 patients. Three patients were asymptomatic: 1 had a small hemangioma on the glans penis, and 2 had small hydroceles. In the remaining 3 patients there were signs commensurate with symptoms: 1 had outflow tract obstruction and, on rectal examination, benign enlargement (30 Gm.) of the prostate; 2 complained of dysuria and in each a tender prostate was noted on examination. All patients were normotensive. In all 26 patients urine specimens were normal on microscopic examination and bacteriologic
Hemospermia implies the presence of blood in the ejaculate. Occasionally, the symptom may be associated with hypertension, prostatitis, genitourinary tuberculosis, or carcinoma of either the prostate or seminal vesicles. The exact significance of the condition is not clear, and we have therefore studied a group of patients whose primary complaint was hemospermia. Material
and Methods
Twenty-six patients with hemospermia as a primary complaint were seen in the period from 1969 to 1974. Twenty-three were Caucasian born in the United Kingdom, 2 were West Indian, and 1 Guyanan. Ages ranged from eighteen to sixtythree years (mean thirty-nine years). Fourteen were married. A full history (including sexual history) and clinical examination were made. A full blood count, including platelets, was done, and biochemical screening with measurements of serum acid phosphatase was undertaken in some patients. Urine specimens were obtained for microscopic examination and bacteriologic culture, and three early morning specimens were examined for tuberculosis. Excretion urogram and diagnostic panendoscopy were performed. Results The interval between the first episode of hemospermia and request for medical advice varied between seven days and eighteen months, but
UROLOGY
/ SEJTEMBER
1975 / VOLUME
VI, NUMBER
3
331
culture. In none of 18 patients examined were acid-fast bacilli found in the urine. Hematologic findings and biochemical profile were normal in all 23 patients examined, and the serum acid phosphatase was normal in 12 patients in whom it was measured. Twenty-four patients had excretion urography; signs of outflow tract obstruction were seen in 1 patient, and the remainder were normal. Panendoscopy was performed in 20 patients, and in 2 the results were abnormal. The presence of outflow tract obstruction was confirmed in the patient with an abnormal pyelogram, and another patient was judged to have clinically significant median lobe enlargement treated by transurethral resection. Comment Primary hemospermia is not a rare condition, 26 cases being seen at our clinic over the past five years. However, there is little guide from the literature on the significance of this symptom and particularly how far it needs to be investigated. A search of the literature for the past ten years revealed no studies of hemospermia. It would appear that patients with hemospermia fall naturally into two groups. The first are
332
those patients with hemospermia as their only urologic symptom, who, on clinical examination, are normal. In these patients there is no obvious precipitating cause, and more particularly our results suggest that changes in sexual activity play no part in its causation. Eighteen of our patients were in this group, and further detailed urologic examination was normal in all. In the second group, there is either an obvious precipitating cause, or on direct questioning, patients admit to other urologic symptoms. Eight of our patients were in this group: 4 had an obvious clinical cause for hemospermia (trauma, hemophilia, hemangioma of the glans penis), and of the remaining 4 with other urologic symptoms, abnormal clinical findings were noted in 2. These results suggest that patients with primary hemospermia as the only symptom need no further investigation, whereas, those with hemospermia and other urologic symptoms require further investigation. Hammersmith Hospital Du Cane Road London W12 OHS, England (DR. CASTRO)
UROLOGY
/ SEPTEMBER1975
/ VOLUMEVI,
NUMBER3
