Gönültaş Serkan, Baydilli Numan, Solakhan Mehmet, Güzel Ahmet, Kardaş Sina, Demirci Aykut, Sulejman Suhejb, Yentür Serhat, Ertaş Kemal, Köse Mustafa Gökhan, Bulut Berk, Gelmiş Mücahit, Bozlu Murat, Kadıoğlu Ateş
Clinic of Urology, University of Health Sciences Türkiye, Gaziosmanpaşa Training and Research Hospital, İstanbul, Türkiye.
Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Türkiye.
Balkan Med J. 2025 May 5;42(3):212-221. doi: 10.4274/balkanmedj.galenos.2025.2024-12-37.
Hematospermia is defined as the presence of blood in the semen. The data regarding its etiology and management is variable across the literature.
To investigate the etiology of hematospermia in Türkiye so as to contribute to the current management strategies for hematospermia.
An online study protocol was published through the Turkish Urology Association communication network, and the centers that met the criteria were included in the study. All patients who presented with hematospermia complaints in the past 1 year were subjected to detailed anamnesis, physical examination, and routine laboratory tests. Based on the results, the patients were assigned to Group 1 (patients aged < 40 years with only one episode of hematospermia in the past 6 months) or Group 2 (patients with concomitant symptoms or ≥ 40 years or ≥ 2 times in the past 6 months). Radiological imaging was performed for the patients in Group 2.
A total of 199 patients (Group 1: 44, Group 2: 155; mean age: 43.07 ± 14.73 years; age range: 16-73 years) from across 42 cities and 22 different centers were enrolled in this study. In the etiological classification, inflammation was identified as the most common cause (n = 76, 38.1%). Idiopathic hematospermia was higher in Group 1 than in Group 2 (70.4% vs. 112.2%, respectively), and hematospermia was associated with malignancy in 9 (5.8%) Group 2 patients. Positivity was detected in urine or semen cultures in 20 (12.9%) patients, and hematospermia occurred after COVID-19 infection in 2 patients. A significant correlation was noted between patients showing no-concomitant symptoms and those showing idiopathic hematospermia, inflammation, malignancy, varicocele, and multiple etiological factors ( = 0.004, = 0.028, = 0.002, = 0.001, = 0.026, = 0.016). The most common radiological findings were an increase in the prostate volume (n = 48, 30.9%) and changes in the signal intensities of the seminal vesicles (n = 29, 18.7%). Despite the use of different approaches to manage idiopathic hematospermia, the patients' survey results were generally similar.
Hematospermia in all age groups occurs generally due to self-limiting benign causes. Diagnostic imaging should therefore evaluate the elucidate etiology in patients with identified risk factors so as to avoid unnecessary treatments in idiopathic patients.
血精症定义为精液中出现血液。关于其病因和治疗的数据在文献中各不相同。
调查土耳其血精症的病因，以促进当前血精症的管理策略。
通过土耳其泌尿外科学会通讯网络发布在线研究方案，符合标准的中心纳入研究。所有在过去1年出现血精症症状的患者均接受详细问诊、体格检查和常规实验室检查。根据结果，将患者分为1组（年龄<40岁且在过去6个月仅有一次血精症发作的患者）或2组（伴有伴随症状或年龄≥40岁或在过去6个月内发作≥2次的患者）。对2组患者进行放射影像学检查。
本研究共纳入来自42个城市和22个不同中心的199例患者（1组：44例，2组：155例；平均年龄：43.07±14.73岁；年龄范围：16 - 73岁）。在病因分类中，炎症被确定为最常见原因（n = 76，38.1%）。1组特发性血精症高于2组（分别为70.4%对112.2%），2组中有9例（5.8%）患者血精症与恶性肿瘤相关。20例（12.9%）患者尿液或精液培养呈阳性，2例患者在新冠病毒感染后出现血精症。无伴随症状的患者与特发性血精症、炎症、恶性肿瘤、精索静脉曲张和多种病因之间存在显著相关性（= 0.004，= 0.028，= 0.002，= 0.001，= 0.026，= 0.016）。最常见的放射学表现是前列腺体积增大（n = 48，30.9%）和精囊信号强度改变（n = 29，18.7%）。尽管采用了不同方法治疗特发性血精症，但患者的调查结果总体相似。
各年龄组的血精症通常由自限性良性原因引起。因此，诊断性影像学检查应评估已识别危险因素患者的病因，以避免对特发性患者进行不必要的治疗。
