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Suh Y, Gandhi J, Joshi G, Lee MY, Weissbart SJ, Smith NL, Joshi G, Khan SA. Etiologic classification, evaluation, and management of hematospermia. Transl Androl Urol 2017; 6:959-972. [PMID: 29184797 PMCID: PMC5673809 DOI: 10.21037/tau.2017.06.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hematospermia is defined by the presence of blood in the semen typically occurring in men younger than 40 years of age. Symptoms can occur due to a multitude of reasons, but are usually benign and self-limiting, requiring no additional treatment or evaluation. Despite this, the condition often impairs quality of life due to associated anxiety and must be taken seriously by the patient and the physician, particularly if recurrent, refractory, and painful. The etiology of hematospermia can be classified into inflammatory, infectious, lithiasis, cystic, obstructive, tumoral, vascular, traumatic, iatrogenic, and systemic origin. Alternatively, it can also be divided into subcategories based on anatomical origins such as prostate, bladder, spermatic cord, seminal vesicles, or epididymis. A complete history and physician examination, laboratory testing, and a variety of invasive and non-invasive imaging and instrumentation modalities can help to identify and treat the underlying pathology promptly.
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Affiliation(s)
- Yiji Suh
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Medicine at Southampton Hospital, Southampton, NY, USA
| | - Min Yea Lee
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Abstract
PURPOSE With current diagnostic modalities the proportion of patients diagnosed with idiopathic hemospermia has decreased dramatically. The dilemma now is how far to investigate these patients since in the majority it is a benign and self-limiting symptom. MATERIALS AND METHODS We reviewed the literature on hemospermia with particular emphasis on etiology, diagnosis and management. A Medline search of the literature for the last 40 years was done and all relevant articles were studied in full. RESULTS Etiological factors are often categorized into the various pathophysiological mechanisms. Most cases of hemospermia are the result of iatrogenic, inflammatory and infective pathologies. A literature review of the etiological studies of hemospermia identified a total of 33 tumors (25 prostatic) in 931 cases (3.5%). In patients younger than 40 years an infective cause in the urogenital tract is the most common etiological factor. Often only simple, tailored investigations and appropriate treatment are required. In patients older than 40 years with persistent hemospermia or associated symptoms such as hematuria it is essential to exclude urogenital malignancy. History, examination and simple investigation should also suffice in this group. If the diagnosis is still unclear, further investigation in the form of transrectal ultrasound, magnetic resonance imaging and cystoscopy is of proven benefit. Treatment for hemospermia depends on the underlying pathological condition. In most cases bleeding is slight and self-limited, and it may be managed expectantly. CONCLUSIONS The majority of patients can be treated with minimal investigations and simple reassurance. In older patients or those with persistent hemospermia or associated symptoms modern diagnostic techniques are of proven benefit.
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Affiliation(s)
- Imran Ahmad
- Department of Urology, Ayr Hospital, Ayr, Scotland, United Kingdom.
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3
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Abstract
Hematospermia is an anxiety provoking but otherwise generally benign and self-limited condition that is infrequently associated with significant underlying pathology, and is most often considered to be idiopathic in nature. Management with routine clinical evaluation, watchful waiting, and reassurance generally suffice without further diagnostic workup or treatment. Noninvasive imaging may play an important role in the diagnostic workup of men with hematospermia, particularly in those who are >40 years old, have other associated symptoms or signs of disease, or have persistence of hematospermia. Many entities may be encountered in association with hematospermia at imaging, and specific therapeutic interventions may be used if certain treatable underlying pathologies are coincidentally detected. In this comprehensive review, we discuss the potential etiologies, diagnostic workup, imaging techniques, relevant male pelvic anatomy, imaging appearance of specific associated pathologies, and treatment for hematospermia.
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Affiliation(s)
- D A Torigian
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Sánchez Merino JM, Fernández Flores A, Gómez Cisneros SC, Parra Muntaner L, García Alonso J. [Ectopic prostatic tissue in the bladder]. Actas Urol Esp 2002; 26:369-71. [PMID: 12174748 DOI: 10.1016/s0210-4806(02)72793-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 58-year-old man with ectopic prostatic tissue at the bladder trigone. The diagnosis was by chance during study and treatment of benign prostatic hyperplasia. The appearance was pseudocystic. It occupied completely the bladder trigone. On histology, the lesion was formed by prostatic type-glands, which were positive for the presence of prostatic specific antigen by using inmunoperoxidase technique. It was partially covered by normal urothelium. Ten months later, no trace of recurrence has been evidenced.
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Nucci MR, Ferry JA, Young RH. Ectopic prostatic tissue in the uterine cervix: a report of four cases and review of ectopic prostatic tissue. Am J Surg Pathol 2000; 24:1224-30. [PMID: 10976696 DOI: 10.1097/00000478-200009000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report four examples of prostatic tissue occurring in the uterine cervix of patients aged 22, 25, 31, and 77 years. Three were incidental findings in loop excisions (two patients) and cone biopsy (one patient) of the cervix for high-grade squamous dysplasia. One presented as a cervical mass, clinically suspected to represent a fibroid. The prostatic tissue consisted of ducts and acini, some of which had papillary or cribriform patterns. Squamous metaplasia was prominent in all cases. No Wolffian duct tissue was present. The glandular epithelium in all cases was positive for prostatic acid phosphatase and prostate-specific antigen. High molecular weight keratin, performed in two cases, highlighted basal cells in a manner similar to the normal prostate. These unusual cases, only one of which is documented previously, further complicate the often-challenging area of interpretation of benign glandular lesions of the cervix. The unusual phenomenon of ectopic prostate tissue in general is reviewed.
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Affiliation(s)
- M R Nucci
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Ito T, Furusato M, Akiyama A, Kato H, Aizawa S. A clinical and immunohistochemical study of papillary adenocarcinoma of the prostate. Prostate 1995; 26:23-7. [PMID: 7531325 DOI: 10.1002/pros.2990260106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Clinical and immunohistochemical studies were conducted to evaluate prostatic papillary adenocarcinoma and prostatic papillary hyperplasia. Subjects consisted of 5 cases of papillary adenocarcinoma and 2 cases of papillary hyperplasia. There is no conclusive clinical factor for preoperative diagnosis, but we attach importance to endoscopic findings. PSA, PAP, high molecular weight cytokeratin, and PCNA were evaluated immunohistochemically. PSA became positive in every instance but one--a case of papillary adenocarcinoma which became +/-. PAP was + in all cases, except for 1 case of papillary adenocarcinoma. Basal cells were positive for high molecular weight cytokeratin in 2 cases of papillary hyperplasia but were missing in papillary adenocarcinoma. Although PCNA was free from positive nuclei in papillary hyperplasia, positive nuclei were found in all cases of papillary adenocarcinoma. Considering these immunohistochemical results, papillary adenocarcinoma can be said to originate in the glandular epithelium of the prostate, as does ordinary prostatic carcinoma.
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Affiliation(s)
- T Ito
- Department of Pathology, School of Medicine, Jikei University, Tokyo, Japan
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Abstract
Haematospermia, blood in the ejaculate, is a symptom which provokes great anxiety in patients due to fears of malignant or sexually transmitted disease. However, there is no evidence from the published literature to associate it with any serious pathology. The large series of cases indicate that investigation is unproductive and that patients do not develop serious disease even after prolonged follow-up. Patients presenting with haematospermia warrant a full physical examination, including rectal examination, but in the absence of physical signs they should then be strongly reassured. Further investigation is unnecessary. Coexistent urological symptoms should be investigated appropriately.
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Abstract
A unique case is reported of ectopic prostatic tissue present within the anal submucosa from a routine ischial decubitus resection specimen. Although ectopic prostatic tissue has been reported at loci adjoining the prostate, most notably within the urethra, this case is noteworthy by merit of its disparate location.
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Affiliation(s)
- M B Morgan
- Department of Pathology, University of South Florida, College of Medicine, Tampa
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Congleton L, Thomason WB, McMullan DT, Worsham GF. Painless hematuria and urethral discharge secondary to ectopic prostate. J Urol 1989; 142:1554-5. [PMID: 2685371 DOI: 10.1016/s0022-5347(17)39162-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a case of ectopic prostatic tissue found in the penile urethra of a 16-year-old boy. A literature review and discussion of this rare entity are presented.
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Affiliation(s)
- L Congleton
- Department of Urology, Medical University of South Carolina, Charleston
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Sogbein SK, Steele AA. Papillary prostatic epithelial hyperplasia of the urethra: a cause of hematuria in young men. J Urol 1989; 142:1218-20. [PMID: 2810497 DOI: 10.1016/s0022-5347(17)39034-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We describe 4 cases of gross hematuria in young men due to papillary urethral lesions composed of prostatic-type epithelium. The clinical presentation, cystourethroscopic and pathological findings, and management are reviewed. A possible histogenesis is proposed based on a comparison of surgical biopsy tissues from 4 cases with prostatic urethral sections of 8 autopsy cases with no known genitourinary problems.
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Affiliation(s)
- S K Sogbein
- Department of Surgery, North Bay Civic Hospital, Ontario, Canada
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