Satchi Maria, Katelaris Athos, Smekal Martina, Alnajjar Hussain M, Muneer Asif
Department of Urology, Institute of Andrology, University College London Hospitals NHS Trust, London, UK.
NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
Curr Urol. 2022 Mar;16(1):44-49. doi: 10.1097/CU9.0000000000000080. Epub 2022 Jan 28.
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.
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.
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% ( = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% ( = 81) had a positive finding.
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.
血精症虽常被认为是一种良性病症，但可能是一个令人担忧的迹象。因此，患者可能会接受多项检查，而目前尚无基于大量数据的标准化检查流程。本研究的目的是评估潜在病理状况的发生率以及对血精症患者进行诊断性检查的价值。
在一家单一的三级中心对393例连续接受血精症检查的男性进行了回顾性研究。记录了患者的人口统计学资料、放射学和微生物学检查结果，以及血尿症状和临床结局。
在该队列中，总体前列腺癌检出率为5.3%，≥40岁组为7.2%。1例患者经阴囊超声检查诊断为睾丸精原细胞瘤，1例经软性膀胱镜检查诊断为膀胱G1pTa期尿路上皮癌。此外，5.6%的患者被发现有需要干预的明显良性病变。共有288例患者接受了经直肠超声检查，其中58.7%（=169）的患者检查结果为阳性。110例患者接受了多参数磁共振成像检查，其中73.6%（=81）的患者检查结果为阳性。
除经直肠超声和多参数磁共振成像外，其余检查的诊断率较低。前列腺癌检出率为5.3%；≥40岁组为7.2%，另有2例患者被诊断为睾丸和膀胱恶性肿瘤。基于我们的研究结果，我们提出了一种血精症管理算法，以限制不必要的检查，大多数患者需要安心。
