Hematospermia: norm or pathology? Modern approaches to etiopathogenesis, diagnosis and treatment

Abstract

In most cases, the cause of blood appearance in the semen remains unknown. According to WHO, about 15 % of men experience only one episode of hematospermia, which is never repeated again. Hematospermia cause determination includes clinical examination by an urologist-andrologist and thorough patient history. The main purpose of the examination is to diagnose or exclude andropathology and also to determine the tactics of patients with hematospermia treatment. Aim. To show the relevance of this problem in reproductive medicine, to describe ethiopatogenesis of hematospermia and consider the basic methods of this pathological symptom modern diagnosis and treatment based on the specialized literature data analysis. The presence of blood in the semen can indicate a serious disease, which is the result of andropathology. The exact percent of hematospermia cases is unknown, because ejaculates go unnoticed in the process of unprotected intercourse. The most of patients consult a specialist immediately after the first episode of hematospermia. The basic points are a clinical examination and careful anamnesis. The main purpose of patients with hematospermia examination is determination of the cause or specific condition, which must be cured, and thus the symptomatology and pathological condition irradiation. To confirm the fact of hemospermia, if it’s necessary, a "contraceptive test" can be used, which consists of pathological ejaculate collection into a condom for examination. Further an urologist-andrologist examine the patient, find out an anamnesis, assign a seminal fluid analysis, a clinical and urine culture analysis, a test of blood clotting factors, a clinical blood analysis, ultrasound of the prostate by the TRUS method, prostate-specific antigen (PSA) test, alpha-fetoprotein (AFP), β-subunit of human chorionic gonadotropin (hCG) and blood serum lactate dehydrogenase (LDH) for oncopathology exclusion. Etiologic factor elimination is essential for patients with hemospermia treatment. Due to increased amount of literature data and great advances in the ultrasound diagnostics, many causes of hemospermia have been identified, so the methods of this symptom treatment are also various: conservative and surgical, which completely depend on the etiologic factor. If the pathological condition is not found, then the doctor should be as a psychotherapist to correct the sexual behavior in such men. Conclusions. Blood in the semen can evidence a serious disease, which is the result of andropathology. To determine the cause of hematospermia, it is necessary to perform a clinical examination by an urologist-andrologist and careful anamnesis. The main purpose of examination is to identify or exclude the pathology and, if it is not defined, doctor should encourage the patient on his good health. There are obligatory procedures: a seminal fluid analysis, a clinical and urine culture analysis, a test of blood clotting factors, a clinical blood analysis and ultrasound examination of the prostate by the TRUS method, PSA, AFP, hCG, LDH blood serum tests for malignant etiology of hematospermia exclusion. Modern methods of investigation allow identifying cause of hematospermia in many cases and the most patients are treated conservatively depending on the etiologic factor, but also surgical correction can be used.

Keywords

• hematospermia
• review
• andrology
• diagnosis