Hematospermia and Hematuria: Causes and Concerns

Q: Hematospermia and Hematuria: Causes and Concerns

Hello： Hematospermia and visible hematuria should be carefully examined, as hematospermia can easily recur. <br>It is recommended to return for a follow-up if symptoms occur. <br>Wishing you good health.

Hematospermia and hematuria?

Hello Doctor: Earlier this year, I went to the hospital for an examination due to hematospermia and was found to have some prostatic calcifications.
Later, I underwent a seminal vesiculoscopy and stones were discovered at the ejaculatory duct, which the doctor said were completely removed.
However, less than six months later, the issue recurred.
This time, the semen appeared normal, but the first part of my urine was bloody and contained clots.
The doctor diagnosed a urinary tract infection and prescribed antibiotics, advising abstinence for two weeks.
(Routine urinalysis has always been normal; bacteria were only detected during DIY after experiencing hematuria.) After the abstinence period, I attempted DIY and the first time was normal, but a few days later, during another attempt, I noticed fresh blood in the latter part of the semen, although the hematuria was minimal.
Could this indicate the presence of stones again? Is it related to the prostatic calcifications, or could it simply be a urinary tract infection or prostatitis?

Owen, 30~39 year old female. Ask Date: 2022/06/11

Dr. Du Shixi reply Urology

Hello: Hematospermia and visible hematuria should be carefully examined, as hematospermia can easily recur.
It is recommended to return for a follow-up if symptoms occur.
Wishing you good health.

Reply Date: 2022/06/11

More Info

Understanding hematospermia (the presence of blood in semen) and hematuria (the presence of blood in urine) can be concerning for many patients, especially when these symptoms recur or change in nature. Based on your description, it seems you have experienced a series of urinary and reproductive health issues, including prostate calcifications, the presence of stones in the seminal vesicles, and recurrent urinary tract infections (UTIs).

Causes of Hematospermia and Hematuria
1. Prostate Issues: Prostate calcifications can sometimes lead to inflammation or infection, which may contribute to both hematospermia and hematuria. The prostate gland is closely linked to the reproductive and urinary systems, and any inflammation or infection can cause bleeding in either system.

2. Seminal Vesicle Stones: The presence of stones in the seminal vesicles can also lead to bleeding. If these stones irritate the lining of the seminal vesicles, they can cause inflammation and bleeding, which may manifest as blood in the semen.

3. Urinary Tract Infection (UTI): UTIs are a common cause of hematuria. The infection can irritate the bladder and urethra, leading to bleeding. In your case, the fact that you have a history of UTIs and that bacteria were found in your urine during these episodes suggests that this could be a contributing factor.

4. Injury or Trauma: Any trauma to the pelvic area, whether from medical procedures or other causes, can lead to bleeding in either the semen or urine.

5. Other Conditions: Conditions such as benign prostatic hyperplasia (BPH), prostatitis (inflammation of the prostate), or even more serious conditions like prostate cancer can also lead to these symptoms.

Your Recent Symptoms
Given that you experienced blood in your urine and semen after a period of normalcy, it is essential to consider the following:
- Recurrent Stones: It is possible that you may have developed new stones in the seminal vesicles or urinary tract. Stones can recur, and their presence can lead to irritation and bleeding.

- Infection: Since you mentioned that the first urine after ejaculation showed signs of infection, it is plausible that the infection has not fully resolved or that a new infection has developed.
- Prostate Inflammation: The symptoms you describe could also be indicative of prostatitis, which can cause both hematospermia and hematuria.

Recommendations
1. Follow-Up with a Urologist: Given your history and the recurrence of symptoms, it is crucial to follow up with a urologist. They may recommend imaging studies, such as an ultrasound or CT scan, to check for stones or other abnormalities in the urinary tract and prostate.

2. Urinalysis and Culture: A repeat urinalysis and urine culture can help determine if there is an ongoing infection that needs to be treated.

3. Prostate Evaluation: A thorough evaluation of the prostate, including possible digital rectal examination (DRE) and prostate-specific antigen (PSA) testing, may be warranted to rule out any serious conditions.

4. Avoid Irritants: Until you have a clearer understanding of the cause, it may be wise to avoid activities that could irritate the urinary tract, such as vigorous sexual activity or the use of irritative substances.

5. Hydration: Staying well-hydrated can help flush out the urinary system and may alleviate some symptoms.

Conclusion
While hematospermia and hematuria can be alarming, they are often treatable once the underlying cause is identified. Your symptoms could be related to a combination of factors, including prostate issues, infections, or stones. It is essential to seek medical advice promptly to ensure appropriate diagnosis and treatment. Remember, timely intervention can prevent complications and lead to better health outcomes.

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