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Coleman-Belin J, Amakiri UO, Deng FM, Hoskoppal D, Safer JD, Reisman T. Hematospermia in a Transgender Woman with Evidence for Endometrial Tissue in the Prostate. AACE Clin Case Rep 2024; 10:80-83. [PMID: 38799045 PMCID: PMC11127599 DOI: 10.1016/j.aace.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 05/29/2024] Open
Abstract
Background/Objective The frequency of hematospermia in transgender women is unknown. This report aimed to describe the development of hematospermia in a transgender woman. Case Report A 35-year-old transgender woman treated with estradiol valerate and leuprolide presented with painless rust-tinged ejaculate, urethral bleeding after ejaculation, and intermittent hematuria. Her medical history included gastroesophageal reflux disease, internal hemorrhoids, and attention deficit hyperactivity disorder with negative tobacco smoking and urologic history. Additional medications included emtricitabine-tenofovir disoproxil fumarate and fexofenadine. Physical examination did not reveal constitutional or genitourinary abnormalities. Urinalysis and culture disclosed rare white blood cells with gram-variable bacilli. The chlamydia, gonorrhea, and human immunodeficiency virus test results were negative. Abdominal computed tomography did not reveal bladder or prostate cancer, calcifications, inflammation, or cysts. She continued to have symptoms after this initial workup. One year after the initial symptom onset, transrectal ultrasound disclosed a 1.7-cm midline posterior prostatic cyst with hemorrhagic products, later revealed by magnetic resonance imaging as communicating with the left seminal vesicle. Two ultrasound-guided transperineal biopsy samples revealed benign prostatic tissue with a small focus of Müllerian or endometrial-type tissue, evidenced by immunopositivity for paired-box gene 8 and estrogen receptor in epithelium and cluster of differentiation 10 immunopositivity in stroma. After medical consultation, the patient underwent prostatic cyst aspiration, resection of the transurethral ejaculatory ducts, and orchiectomy. She did not experience any complications after these procedures. Discussion The etiology of hematospermia may be idiopathic, iatrogenic, anatomic, or pathologic. Conclusion Occult endometriosis or ectopic Müllerian epithelial tissue growth may occur in transgender women taking feminizing gender-affirming hormone therapy.
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Affiliation(s)
- Janet Coleman-Belin
- Icahn School of Medicine at Mount Sinai, New York, New York
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
| | - Uchechukwu O. Amakiri
- Icahn School of Medicine at Mount Sinai, New York, New York
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
| | - Fang-Ming Deng
- Department of Pathology and Urology, New York University Langone School of Medicine, New York, New York
| | - Deepthi Hoskoppal
- Department of Pathology, New York University Langone School of Medicine, New York, New York
| | - Joshua D. Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
- Division of Endocrinology, Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tamar Reisman
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York
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Sood V, Bhairavabhatla V, Pattanayak S, Singh V. Recurrent haematospermia: an unusual presentation of autosomal dominant polycystic kidney disease. BMJ Case Rep 2022; 15:e251868. [PMID: 36357099 PMCID: PMC9660571 DOI: 10.1136/bcr-2022-251868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Haematospermia, even though alarming, is usually benign and self-limiting, especially in a sexually active male. Nevertheless recurrent, refractory or painful haematospermia is troublesome and warrants thorough evaluation. In this context, we describe a rare case of recurrent haematospermia whereby evaluation revealed haemorrhage in seminal vesicle cysts and consequently established the aetiology of autosomal dominant polycystic kidney disease.
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Affiliation(s)
- Vivek Sood
- Nephrology, Army Hospital Research and Referral, New Delhi, India
| | | | - Somali Pattanayak
- Radiodiagnosis, Army Hospital Research and Referral, New Delhi, India
| | - Vishal Singh
- Nephrology, Army Hospital Research and Referral, New Delhi, India
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Detection rates of urogenital cancers and benign pathology in men presenting with hematospermia. Curr Urol 2022; 16:44-49. [PMID: 35633853 PMCID: PMC9132186 DOI: 10.1097/cu9.0000000000000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Hematospermia, although often found to be a benign condition, can be an alarming sign. Consequently, patients can undergo multiple investigations with no current standardized pathway based on data from large series. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia. Materials and methods: A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center. Patient demographics, radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes. Results: In this cohort, the overall prostate cancer detection rate was 5.3% and 7.2% in the ≥40 years group. One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy. In addition, 5.6% of patients were found to have a significant benign pathology for which intervention was proposed. A total of 288 patients underwent a transrectal ultrasound scan and 58.7% (n = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% (n = 81) had a positive finding. Conclusions: Apart from transrectal ultrasound and multiparametric magnetic resonance imaging, the remaining investigations have a low diagnostic yield. Prostate cancer detection was 5.3%; 7.2% in the ≥40 years group, and two further patients were diagnosed with testicular and bladder malignancy. Based on our results, we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.
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Rana A, Aggarwal A, Bairwa L, Prasad V. Hematospermia Due to Giant Hemorrhagic Prostatic Utricle Cyst with Benign Mural Nodule. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Han H, Lei HE, Zhang XD, Tian L. Magnetic resonance imaging compared to ultrasound as the preferred method for diagnosing intractable haematospermia. Andrologia 2021; 53:e14054. [PMID: 33955038 PMCID: PMC8244118 DOI: 10.1111/and.14054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/12/2023] Open
Abstract
We aimed to evaluate and compare the clinical diagnostic values of magnetic resonance imaging (MRI) and ultrasound in patients with intractable haematospermia. We performed a retrospective review of 23 patients with intractable haematospermia who were diagnosed with seminal vesicle haematocele and/or calculi by transurethral seminal vesiculoscopy (TSV). Patients’ demographics, disease durations, operative times, and MRI and transrectal ultrasound (TRUS) results were recorded. McNemar's test was used to compare the positive diagnostic rates of MRI and TRUS. All patients had undergone preoperative seminal vesicle MRI and TRUS to identify the aetiology of the haematospermia. The average age and disease duration were 39.3 years and 24.1 months, respectively. The mean operative time was 81.1 min. The positive result rates for MRI and TRUS were 95.7% (22/23) and 39.1% (9/23), respectively. Compared with TRUS, MRI had a significantly higher preoperative positive diagnostic rate (p < 0.01). These results suggest that MRI should be considered as a method for diagnosing intractable haematospermia in patients when TRUS findings are negative or inconclusive.
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Affiliation(s)
- Hu Han
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hong-En Lei
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dong Zhang
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Long Tian
- Department of Urology, Institute of Urology, Capital Medical University, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Wang R, Chen L, Bai X, Li T, Wu D, Chen J. Transrectal ultrasound-guided seminal vesicle catheterization with continuous antibiotic infusion for the treatment of refractory hematospermia. Exp Ther Med 2020; 21:32. [PMID: 33262818 PMCID: PMC7690242 DOI: 10.3892/etm.2020.9464] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to describe transrectal ultrasound (TRUS)-guided seminal vesicle catheterizations with continuous antibiotic infusion in patients with persistent hematospermia. A retrospective record review of 45 patients with refractory hematospermia treated with TRUS-guided seminal vesicle catheterization between 2010 and 2017 was performed. Seminal vesicle puncture and catheterization was performed under TRUS guidance for all patients. Antibiotic irrigation was used to rinse the seminal vesicle until the outflow fluid was clear. The trocar sleeve was left in situ and fixed on the skin of the perineum at the end of the procedure. All patients underwent a 24-h continuous infusion of antibiotic solution through the catheter. The patients were followed up to 3 years for the presence of hematospermia. The duration of refractory hematospermia was between 6 months and 9 years. A total of 14 patients exhibited consecutive hematospermia, while the remaining patients exhibited intermittent episodes. On TRUS, 15 cases of ejaculatory duct cyst, 7 cases of ejaculatory duct expansion, 3 cases of ejaculatory duct stones, 6 cases of seminal vesicle expansion, 8 cases of seminal vesicle stones and 5 cases of seminal vesicle wall or ejaculation wall calcification were diagnosed. A total of 41 patients completed the scheduled treatment plan; however, the catheter was dissociated on the 3rd or 4th day of catheterization in 4 patients. After a 1-3 year follow-up, hematospermia was not observed in 42 patients (93.33%) with recurrence in the remaining 3 patients. In conclusion, TRUS-guided seminal vesicle catheterization with continuous antibiotic infusion appeared to be a safe and effective method for the treatment of hematospermia.
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Affiliation(s)
- Ren Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Lei Chen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Xiaojun Bai
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Tingting Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Dan Wu
- Children Health Care Center, Shanghai Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200060, P.R. China
| | - Jinjin Chen
- Children Health Care Center, Shanghai Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200060, P.R. China
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Khodamoradi K, Kuchakulla M, Narasimman M, Khosravizadeh Z, Ali A, Brackett N, Ibrahim E, Ramasamy R. Laboratory and clinical management of leukocytospermia and hematospermia: a review. Ther Adv Reprod Health 2020; 14:2633494120922511. [PMID: 32577619 PMCID: PMC7290265 DOI: 10.1177/2633494120922511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
Leukocytospermia and hematospermia are defined as the presence of abnormally high white blood cell and red blood cell concentration in the semen, respectively. Numerous etiologies and various implications on fertility have been identified. In a small proportion of men, the presence of white blood cells or red blood cells can adversely affect sperm quality by the production of reactive oxygen species. Several methods have been used to assess the presence of white blood cells and red blood cells in samples, such as identification of round cells, immunohistochemical staining using monoclonal antibodies, the Endtz test, the peroxidase test, and flow cytometry or microscopy. In addition, techniques have been identified to separate sperm samples from white blood cells and red blood cells for cryopreservation to improve outcomes in assisted reproductive technology. In this review, laboratory and clinical management of leukocytospermia and hematospermia are discussed. Currently available diagnostic methods and treatment options are outlined, and available optimal cryopreservation techniques for samples with white blood cells or red blood cells are summarized.
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Affiliation(s)
- Kajal Khodamoradi
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Manish Kuchakulla
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Manish Narasimman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Zahra Khosravizadeh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aleena Ali
- Des Moines University, Des Moines, IA, USA
| | - Nancy Brackett
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Emad Ibrahim
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1563, Miami, FL 33136, USA
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Martínez-Girón R, Martínez-Torre S. Voided urine cytology in a case of hematospermia. Diagn Cytopathol 2019; 47:1237-1239. [PMID: 31364283 DOI: 10.1002/dc.24286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/12/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Rafael Martínez-Girón
- Departament of Health, Anatomic Pathology and Cytodiagnosis, CFP San Juan de la Cruz, Madrid, Spain
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Liao LG, Li YF, Zhang Y, Li K, Zhu T, Li BJ, Wang Q, Liu XD, Luo Y, Zhou B, Jiang J. Etiology of 305 cases of refractory hematospermia and therapeutic options by emerging endoscopic technology. Sci Rep 2019; 9:5018. [PMID: 30903016 PMCID: PMC6430789 DOI: 10.1038/s41598-019-41123-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
To investigate the surgical outcomes of vesiculoscopy on refractory hematospermia and ejaculatory duct obstruction (EDO), the clinical data (including pelvic magnetic resonance imaging (MRI) examinations and the long-term effects of endoscopic treatment) from 305 patients were analyzed. Four main etiologic groups were found on MRI. We found that 62.0% (189/305) of patients showed abnormal signal intensity in MRI investigations in the seminal vesicle (SV) area. Cystic lesions were observed in 36.7% (112/305) of the patients. The third sign was dilatation or enlargement of unilateral or bilateral SV, which were observed in 32.1% (98/305) of the patients. The fourth sign was stone formation in SV or in an adjacent cyst, which was present in 8.5% (26/305) of the patients. The transurethral endoscopy or seminal vesiculoscopy and the related procedures, including fenestration in prostatic utricle (PU), irrigation, lithotripsy, stone removal, biopsy, electroexcision, fulguration, or transurethral resection/incision of the ejaculatory duct (TURED/TUIED), chosen according to the different situations of individual patients were successfully performed in 296 patients. Fenestrations in PU+ seminal vesiculoscopy were performed in 66.6% (197/296) of cases. Seminal vesiculoscopy via the pathological opening in PU was performed in 10.8% (32/296) of cases. TURED/TUIED + seminal vesiculoscopy was performed in 12.8% (38/296) of cases, and seminal vesiculoscopy by the natural orifices of the ejaculatory duct (ED) was performed in 2.4% (7/296) of cases. Electroexcision and fulguration to the abnormal blood vessels or cavernous hemangioma at posterior urethra were performed in 7.4% (22/296) of cases. Two hundred and seventy-one patients were followed up for 6–72 months. The hematospermia of all the patients disappeared within 2–6 weeks, and 93.0% of the patients showed no further hematospermia during follow-up. No obvious postoperative complications were observed. The transurethral seminal vesiculoscopy technique and related procedures are safe and effective approaches for refractory hematospermia and EDO.
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Affiliation(s)
- Liang-Gong Liao
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China.,Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology, Huazhong, China
| | - Yan-Feng Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China.
| | - Yong Zhang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ke Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Tong Zhu
- Department of Urology, Suining Central Hospital, Suining, Sichuan, China
| | - Bo-Jun Li
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Qi Wang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xu-Dong Liu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yong Luo
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Zhou
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Jiang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, China
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Karatas F, Sahin S, Imamoglu GI, Altinbas M. Panitumumab as a possible cause of hematospermia: what is the mechanism? Future Oncol 2015; 11:3229-31. [DOI: 10.2217/fon.15.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fatih Karatas
- Diskapi Education & Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Suleyman Sahin
- Diskapi Education & Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Göksen Inanc Imamoglu
- Diskapi Education & Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Mustafa Altinbas
- Diskapi Education & Research Hospital, Department of Medical Oncology, Ankara, Turkey
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