Causes and Differentialdiagnosis of Hematospermia

The authors examined the most frequent causes of hematospermia on their clinical material. They describe - in the order of importance - the examinations needed to discover pathological diagnostics. They call the attention to the importance of differentiation of "clear" hematospermia and hemato-pyospermia and review the possible ways of therapy.
Ursachen und Differentialdiagnose der Haematospermie

Zusammenfassung

Anhand eigener Beobachtungen wird zur Problematik der Haematospermie Stellung genommen. Dieses Symptom gelangt nicht so häufig zur Beobachtung, allerdings stellt die Haematospermie ein Symptom dar, das sehr ernst genommen werden muß. Die Autoren unterscheiden zwischen einer „klaren” Haematospermie und einer Pyo-Haematospermie, wenn es sich zusätzlich um eine eitrige Entzündung handelt. Die für die Differentialdiagnose wichtigen einschlägigen Untersuchungsmethoden werden beschrieben. Die wesentlichen Grundsätze der Therapie werden erläutert.     

精囊镜检诊治顽固性血精

目的探讨经尿道精囊镜检诊治顽固性血精的临床应用价值。方法回顾性分析我院自2008年9月以来开展经尿道精囊镜检诊治8例顽固性血精患者的临床资料,结合文献复习顽固性血精的治疗方法。年龄26～55岁,平均42岁,血精病程6～48个月,平均12个月,药物和物理治疗无效。采用7F输尿管硬镜行经尿道精囊镜检。结果 8例精囊镜检手术均成功,手术时间分别为20～75min,平均35min。精囊镜检示慢性炎症5例,精囊结石2例,射精管梗阻扩张1例。无尿道和精囊损伤等并发症。术后随访时间3～24个月,7例患者血精症状消失,1例术后9个月再发血精。结论经尿道精囊镜检操作简单,创伤小,可作为顽固性血精的有效诊治方法之一。     

Pheochromocytoma diagnosed after anticoagulation for atrial fibrillation ablation procedure: A giant in disguise

Pheochromocytoma is a rare catecholamine-producing tumor, discovered incidentally in 50% of cases. We present the case of a 44-year-old male with a history of paroxysmal palpitations. Baseline ECG, transthoracic echocardiogram and ECG stress test showed no relevant alterations. Paroxysmal atrial fibrillation was detected on 24-hour Holter ECG. After antiarrhythmic therapy, the patient remained symptomatic, and was accordingly referred for electrophysiological study and atrial fibrillation ablation. Anticoagulation was initiated before the procedure. After ablation and still anticoagulated, he complained of hematospermia. The abdominal and pelvic imaging study showed a 10-cm left adrenal mass, predominantly cystic, compatible with pheochromocytoma, which was confirmed after biochemical tests (increased urine metanephrines and plasma catecholamines). Metaiodobenzylguanidine scintigraphy scanning confirmed localized disease in the adrenal gland, excluding other uptake foci. Following appropriate preoperative management, surgical resection of the giant mass was performed successfully and without complications.     

经前列腺小囊精囊镜治疗血精56例疗效分析

目的:探讨对血精以经前列腺小囊精囊镜方法进行治疗所取得的临床效果。方法:选择2013年9月至2014年6月期间曾在我院接受治疗的血精患者112例,将这些患者在随机方式之下分为两组,并且分别通过观察组与对照组对这两组患者进行表示,对照组中患者以传统方法对其进行治疗,观察组中患者以经前列腺小囊精囊镜方法进行治疗,观察两组患者的治疗总有效率以及疾病复发率。结果:在手术结束之后,对两组患者的临床治疗总有效率观察,对照组中患者所得到治疗总有效率仅75.0%,观察组中患者所得到临床总有效率高达92.9%,两组患者之间的差别十分明显;对患者进行随访,观察两组患者的复发率,对照组中患者的复发率为17.9%,观察组中患者的复发率为5.4%,两组患者间存在明显差异。结论:选择经前列腺小囊精囊镜对血精进行治疗效果比较理想,可得到较高治疗有效率,使患者临床症状得到有效改善,提高其生活质量,并且复发率比较低,可在临床上广泛应用。     

中药口服加灌肠治疗血精21例

目的观察中药口服加灌肠治疗血精的效果。方法将42例血精患者随机分为观察组和对照组。观察组（21例）采用中药口服加灌肠的治疗方案,对照组（21例）采用西医抗菌消炎加超声波导入的治疗方案。30天为一疗程,进行对比研究,观察其治疗前后症状,判断其临床疗效[1]。结果完成研究38例,提前出院4例。观察组总有效率高于对照组总有效率,差异有统计学意义（P〈0.01）。对照组和治疗组均未见任何不良反应,血精消失。结论中药口服加灌肠治疗血精具有副作用小,见效快,简单易行和价格低廉的优点。     

核磁共振成像对顽固性血精症的诊断价值

目的:探讨顽固性血精症患者盆腔的核磁共振成像(MRI)影像学特点及其临床意义.方法:回顾性分析顽固性血精患者9例,先行盆腔MRI检查之后,8例48h内再行椎管麻醉下经尿道应用超脉冲等离子切割镜对精阜进行去顶状切开,榆尿管镜下对精囊、前列腺内进行观察并与之相对应的影像学特点进行对比分析;1例行前列腺穿刺活检.结果:7例病灶位于精囊(双侧或单侧),大部分精囊腺体积增大,MRI表现为T1WI呈高信号或低信号,T2WI呈低信号或压脂序列呈高信号影;1例病灶位于前列腺中线区,MRI表现为在T1WI序列上见类圆形高信号影,边界清楚,直径约1.8cm,在T2WI及脂肪抑制序列上呈高低混杂信号影,可见分层;1例MRI表现为前列腺体积增高,大小约4.5cm×3.4cm×5.1cm,左后方外周带可见了类圆形灶,呈等T1短T2信号,直径约1.7cm,边界模糊,增强后病灶呈较均匀强化.8例患者进行输尿管镜下观察,发现7例患者在相应精囊(双侧或单侧)存在咖啡色或暗红色胶冻状液体,精囊有不同程度炎性改变.1例前列腺区见囊状肿块内见暗红色液体;1例血精患者盆腔MRI平扫提示前列腺癌,穿刺活检术后证实为前列腺癌.结论:MRI检查能清晰显示精囊、前列腺的病变,对于顽固性血精症患者的诊断及治疗具有重要参考价值.     

前列腺炎与血精

目的：探讨前列腺炎患者血精的发生情况及相互关系。方法：对我院近年来诊治的389例前列腺炎病人中76例合并血精的疗效及相互关系进行分析、总结。结果：389例前列腺炎病人中76例出现血精,约占19．6％,经传统治疗方法治疗后12例有效,占15．9％。结论：血精最常见原因为精囊疾病所致,前列腺炎患者也可出现血精。传统治疗方法对前列腺炎合并血精患者疗效欠佳。     

Detection rates of urogenital cancers and benign pathology in men presenting with hematospermia

Background: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.Materials and methods: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.Results: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% (n = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% (n = 81) had a positive finding.Conclusions: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.     

顽固性血精症原因分析和治疗对策

目的 分析顽固性血精症的原因并探讨其治疗方法,评价经尿道精囊镜技术诊治顽固性血精的临床应用价值.方法 回顾性分析我院单中心25例顽固性血精患者临床资料,结合文献复习顽固性血精的病因和诊治方法.年龄16～67岁,平均38岁,血精病程6个月～17年,平均2.5年,药物和物理等保守治疗无效.21例行经尿道精囊镜检术,另4例分别为生殖系结核(1例)、乙肝肝硬化凝血功能异常(1例)、前列腺癌(2例). 结果 精囊镜检手术时间15～120 min,平均40 min.镜检示精囊慢性炎症出血12例,其中9例继发精囊结石形成,4例射精管或精囊扩张、精囊囊肿并出血3例、射精管梗阻2例.21例精囊镜检术后19例获得随访,2例失访,随访时间3 ～42个月,平均15个月,16例血精症状完全消失,2例分别于术后5个月和9个月再发间歇性血精,较术前减轻,1例精囊囊肿并出血经再次手术治愈.结论 顽固性血精症多由于精囊慢性炎症或继发精囊结石引起,射精管不全梗阻是引起精道反复感染的重要因素.经尿道精囊镜检操作简单,创伤小,可作为顽固性血精的有效诊治方法之一.