What is the treatment for hematospermia?

Treatment of Hematospermia

For most cases of hematospermia, watchful waiting, reassurance, and routine clinical evaluation are sufficient as the condition is typically benign and self-limiting. 1

Age-Based Approach

Men Under 40 Years

• Initial Management:

  • Watchful waiting and reassurance for transient/episodic hematospermia without other symptoms 1
  • No imaging is generally recommended in this population 1

• If infection suspected (most common cause in this age group):

  • Urinalysis and urine culture
  • STI testing (gonorrhea, chlamydia)
  • Appropriate antibiotics if infection confirmed 2, 3

Men 40 Years and Older OR Any Man with Persistent/Recurrent Hematospermia

• Initial Evaluation:

  • Prostate-specific antigen (PSA) testing 2
  • Digital rectal examination
  • Transrectal ultrasound (TRUS) - rated 8/9 for appropriateness 1

• If TRUS is negative or inconclusive:

  • MRI pelvis without and with IV contrast (rated 8/9 for appropriateness) 1
  • MRI pelvis without IV contrast (rated 7/9 for appropriateness) 1

Treatment Based on Etiology

Infectious/Inflammatory Causes

• Appropriate antimicrobial therapy based on culture results
• Anti-inflammatory medications for non-infectious inflammation 3

Ejaculatory Duct Obstruction/Calculi

• Transurethral resection of ejaculatory ducts (TURED) if confirmed by imaging 4
• Endoscopic removal of calculi if present

Vascular Abnormalities

• For intractable hematospermia with identified arterial source:
  • Consider pelvic angiography with possible transcatheter arterial embolization 1

Cystic Lesions

• Aspiration or surgical management based on size and symptoms

Malignancy

• Definitive treatment of primary lesion (prostate, testicular, or seminal vesicle cancer) 3

Special Considerations

Post-Procedural Hematospermia

• Common after prostate biopsy (can persist for 4-6 weeks)
• Reassurance and monitoring only 5

Systemic Causes

• Control of hypertension if present
• Management of bleeding disorders or anticoagulant therapy if relevant 5

Common Pitfalls to Avoid

1. Overlooking age as a risk factor - Men over 40 require more thorough evaluation due to increased risk of malignancy 2

2. Inadequate follow-up - Even if initial evaluation is negative, persistent or recurrent hematospermia warrants continued monitoring

3. Excessive testing in young men with single episode - Can lead to unnecessary anxiety and costs 1, 2

4. Missing systemic causes - Always check blood pressure and consider bleeding disorders in recurrent cases 5

5. Failure to recognize post-procedural causes - Hematospermia is expected after prostate biopsy and typically resolves without intervention 5

Remember that while hematospermia is anxiety-provoking for patients, proper evaluation based on age and associated symptoms will guide appropriate management in most cases.