Polito Massimo, Giannubilo Willy, d'Anzeo Gianluca, Muzzonigro Giovanni
Clinica Urologica, UniversitA Politecnica delle Marche, Azienda Ospedaliera Ospedali Riuniti Ancona, Italy.
Arch Ital Urol Androl. 2006 Jun;78(2):82-5.
The presence of blood in ejaculate represents 1% of all andrologic and urologic symptoms. In most cases it has a benign character and tends to regress spontaneously after the first episode. But in the same case it can be caused by bladder-prostate or systemic malignant patology, so it is necessary to subject the patient to laboratory and instrumental tests in order to find the best treatment that, as for hematospermia, is an etiological one. Most important for correct diagnosis are patient history, physical examination, laboratory tests, transrectal ultrasound examination of the prostate, MRI, CT, cistoscopy. Hematospermia is rarely associated with significant pathology, especially in younger men. The 3 factors that dictate the extent of the evaluation and treatment are patients age, the duration and recurrence of the hematospermia, and the presence of any associated hematuria. So it is possible to distinguish idiopathic from secondary hematospermia, because secondary hematospermia, i.e. the one in which the bleeding cause is known or suspected, requires an etiologic treatment. Urologists must make rational decisions based on evidence rather than practice defensive medicine. Understanding the pathophysiology and prevalence in populations of different ages helps minimize the likelihood of problems. When in doubt, performing a TRUS, cystoscopy, and basic laboratory analyses limits exposure.
血精占所有男科和泌尿系统症状的1%。在大多数情况下，其性质为良性，首次发作后往往会自行消退。但同样情况下，它也可能由膀胱-前列腺或全身性恶性病变引起，因此有必要让患者接受实验室和器械检查，以便找到最佳治疗方法，对于血精而言，最佳治疗方法是针对病因的治疗。正确诊断最重要的是患者病史、体格检查、实验室检查、前列腺经直肠超声检查、磁共振成像（MRI）、计算机断层扫描（CT）、膀胱镜检查。血精很少与严重病变相关，尤其是在年轻男性中。决定评估和治疗程度的三个因素是患者年龄、血精的持续时间和复发情况以及是否存在任何相关血尿。因此，可以区分特发性血精和继发性血精，因为继发性血精，即出血原因已知或疑似的血精，需要进行病因治疗。泌尿外科医生必须基于证据做出合理决策，而不是采取防御性医疗行为。了解不同年龄段人群的病理生理学和患病率有助于将问题发生的可能性降至最低。如有疑问，进行经直肠超声检查、膀胱镜检查和基本实验室分析可减少风险。
