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Urology/Hematospermia/Hematuria worse after cystoscopy

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Hello,

My husband (36 yrs old) was/is having hematuria (blood clots) and hematospermia for the past 4-5 years. When he saw 5 rather large blood clots he went and had urinalysis, a PSA test, Pelvic MRI, CT of the abdomen and a cystoscopy with bladder flushing. All came back negative except the cystoscopy. The doctor saw what he called inflammation in his prostatic urethra. My husband then had a rigid cystoscopy with biopsy. This also came back negative.

Doctor said he has lesions/polyps in his prostatic urethra and more or less has to live with it.

He took 3 weeks to fully recover from the cystoscopy. The burning was terrible for about a week and he was urinating huge blot clots/tissue.

The cystoscopy with biopsy was almost 7 months ago. He has had the hematospermia approximately every 2 weeks.  Except for 1 time there was a break of 6 weeks. There is not usually hematuria but this last time (few days ago) there was a very dark red hematospermia followed by blood (1 tiny clot) in the very beginning of urine 6 or 7 times over 2 days.

Do you think the Cystoscopy is to blame for the frequency of the Hematospermia/Hematuria?  Prior to the surgery it was only happening every 3 months, sometimes longer and the hematuria was happening even less.

Does it take some time to fully heal from this type of surgery?  When I called complaining about the huge blood clots right after the surgery the doctor did say it was more of a resection than a biopsy.

I would very much appreciate your opinion.  Thank you so much.

Answer
Carol, I don't know if you have ever read the "macro" I have written on hematospermia, so I will attach it for you now and then make some comments specific to your husband's problems.

HEMATOSPERMIA:   This type of bleeding usually comes from the prostate gland. It is generally due to a tear in one of the fragile veins of the prostate gland or an inflammation of the prostate (prostatitis).   Bleeding may occur during sexual excitation, ejaculation, from straining with bowel movements, or during urination.  The prostate is the organ that produces the majority of the seminal fluid in response to sexual stimulation. When the prostate contracts at the time of ejaculation, a vein may tear and blood mixes with the semen (hematospermia).  Red blood indicates new and dark (brownish) discoloration indicates previous bleeding. 

In addition, prostatic bleeding frequently is associated with gross blood during urination.  This typically will occur with initiation or at the end of urination (as opposed to being throughout the entire stream). With the latter, it is often manifest as spots of blood on the underwear, pajamas or bed sheets.  Irritation of the gland (prostatitis) can also cause it to become inflamed and predisposed to bleed.  An inflamed or congested prostate gland, especially one with varices, can start bleeding if ones strains during a bowel movement.  This occurs because hard stool can actually push on the adjacent gland precipitating bleeding or straining in itself may cause the varices to rupture.  Some factors leading to inflammation include too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, excessive alcohol or spicy foods, prolonged sitting or bike riding, etc. The prostate may then become secondarily infected and require antibiotic therapy for cure. Sometimes as the prostate gradually enlarges with age, friable veins called varices develop on its surface.   These are also prone to tearing.  In such cases, Proscar or Avodart is sometimes prescribed to shrink both the prostate and the veins.  These are not generally recommended in men less than 40-50 years of age.  Although hematospermia is not a typical sign of prostate cancer, its presence may indicate an increased risk of prostate cancer.  Therefore, it is advisable to seek consultation with a urologist to evaluate this condition.

With respect to your husband, it sounds like he has some degree of prostatitis and I suspect some varices as well.  The "polyps" are usually inflammatory and I agree with his urologist that they in themselves do not require treatment.  Biopsy of the prostate via needle or resecting some tissue endoscopically can stir up some bleeding in these cases.  However, the trauma from this usually heals in 6-8 weeks.  I suggest your husband follow the instructions in the paragraph above regarding ejaculation, alcohol & diet.  These are just as important as medication.  Although hematospermia is relatively common, the degree that he has, is not.  I recommend some blood work to insure that his blood clots properly (such as platelet count, PTT, prothrombin time, etc.). He should have a culture done of the prostatic fluid for bacteria.  If positive, a 6 week course of an appropriate antibiotic can be given to try and clear up any remnant of prostatitis.  If the culture is negative, I would empirically put him on a 6 week course of one of the fluoroquinolones (such as Cipro or Levaquin) assuming he is not allergic  or has other contraindications to its use.  If this does not help, I would consider the long term use of Proscar or Avodart.  Good luck.  

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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