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Urology/Persistent hematospermia

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Question
Dear Doctor,

I am a 50- year old male (just turned) and I have been experiencing consistent hematospermia  for over a year.

Over the last 14 months, I have seen 4 different urologists, done several tests and exams, including semen and prostatic fluid cultures, pelvic MRI, pelvis and lower abdomen ct scan with and without contrast, cystoscopy, transrectal ultrasound, rectal examination, prostate massages. I have also done several cycles of different antibiotics. All to no avail.

All tests have produced negative results and no clear explanation of this persisting condition except an initial diagnosis of prostatitis. I do not experience hematuria or difficulty in or urgency  to hurinate. Just the constant presence of abundant blood in the semen varying in color from bright to slightly darker red .

Since its inception, the hematospermia has briefly diminished in intensity only during one of the first cycles with Bactrim and after a prostatic massage.

The constant presence of blood and not being able to identify the cause are affecting me and are impacting negatively my ability to rest properly and relax.

What other steps should/could I take to find answer for this condition and rule out any serious disease that could have gone undetected?

Thank you in advance for your opinion

Answer
Andrew:

You've already had more testing than we usually do.  We generally assume that hematospermia is benign and self-limiting.  The presence of a tumor or anything serious in the seminal vesicles is pretty much ruled out by the MRI.  Yours sounds like the extremely rare case where no clear cause has been identified despite adequate testing.  Your main issue now is not the bleeding; it's your anxiety.  

The other area to explore is coagulation; to make sure your coagulation is normal. Beyond that I have nothing to suggest as your evaluation has been complete and no cause is identifiable.  That also means that nothing bad was found.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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