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Hematospermia: Blood in Semen (Differential Diagnosis)
Blood in the semen (Hematospermia) is in the overwhelming majority harmless and disappears within a few weeks. In relapsing or persisting hematospermia, further investigations are necessary (see below), but rarely lead to the discovery of relevant diseases.Differential Diagnosis of Hematospermia
- 45% unclear etiology
- Infections (40%): prostatitis, urethritis, epididymitis
- Trauma: prostate biopsy, surgery for hemorrhoids, autoerotic manipulations
- Benign causes: stone in prostate or seminal vesicles, varicose veins of the prostate, anatomical abnormalities (cysts, diverticula, urethral stricture).
- Tumors: condyloma acuminata of the urethra, prostate cancer, carcinoma of the seminal vesicles.
- Systemic diseases: coagulation disorders, hypertension, liver disease, lymphoma.
Diagnostic Workup of Persisting Hematospermia
- History: trauma? Micturition? sexual history? medication? disorders of coagulation?
- Physical examination including blood pressure
- Laboratory tests: PTT, PT, blood count, hepatic function panel, PSA
- Urinalysis: urinary sediment and urine culture (two-glass test)
- Semen analysis and semen culture
- Cystoscopy
- Imaging: transrectal ultrasound of the prostate and seminal vesicles, in case of abnormalities magnetic resonance imaging should be considered.
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