Post-Surgery Hematospermia and Hematuria: Causes and Recovery

Q: Post-Surgery Hematospermia and Hematuria: Causes and Recovery

Hello： May I ask if the issue is due to the surgical wound not fully healing, or is it because blood in the seminal vesicles has not been expelled? -- If the blood is bright red, it indicates fresh bleeding; if it is dark, it is more likely old blood or could potentially be due t

Hematospermia combined with hematuria, with persistent bleeding after surgical treatment?

Several years ago, I experienced hematospermia of unknown origin, which resolved after receiving treatment at a clinic (semen analysis showed no issues).
Recently, I noticed the presence of blood in my semen again, accompanied by significant hematuria (resembling tomato juice).
It typically takes until the third urination for it to return to normal (this phenomenon occurs only after ejaculation).
After undergoing a cystoscopy, the doctor diagnosed me with a polyp growth at the ejaculatory duct, which was determined to be caused by bleeding from microvessels due to increased pressure during ejaculation.
The post-ejaculation hematuria is attributed to the same cause.
Following this, I underwent a urethroscopy where the polyp was cauterized, and a biopsy confirmed it was a benign tumor.
I was advised to rest for about 10 days (the surgery included out-of-pocket growth factor injections), and the blood in my urine due to the surgical site resolved within a week.
During a follow-up visit, the doctor suggested I could attempt sexual intercourse, but I still observed hematospermia (the semen appeared brown with small blood clots).
After the first sexual encounter, my urine was very lightly red, but it returned to normal the following morning.
I am wondering if this is simply due to the surgical site not fully healing or if it could be caused by blood that was not expelled from the seminal vesicles during the procedure (the doctor performed a cystoscopy to check the seminal vesicles, and the results indicated everything was normal; ideally, the semen should have been thoroughly flushed out).
Additionally, the cauterized area should not typically bleed, correct?
Could there be other potential causes for the bleeding? (Both the prostate transrectal ultrasound and cystoscopy indicated normal results.) I have experienced slight discomfort in the perineal area during ejaculation, similar to the soreness felt from excessive ejaculation in youth.
I am currently planning to rest for another week and am hesitant to engage in sexual activity.
Should I rest longer, continue to expel any residual blood, or should I confirm whether there is ongoing bleeding? Thank you.

Kateluofo, 40~49 year old female. Ask Date: 2023/04/20

Dr. Du Shixi reply Urology

Hello: May I ask if the issue is due to the surgical wound not fully healing, or is it because blood in the seminal vesicles has not been expelled? -- If the blood is bright red, it indicates fresh bleeding; if it is dark, it is more likely old blood or could potentially be due to other causes of bleeding? -- Generally, this is unlikely; please discuss with your physician (both the transrectal ultrasound and cystoscopy indicated normal results).
After the surgery or during ejaculation, I experience slight soreness in the perineum, which feels similar to the soreness from excessive ejaculation during my younger years.
-- Currently, I need to pay attention to my lifestyle and diet, and practice safe sexual behavior.
Wishing you good health.

Reply Date: 2023/04/20

More Info

Post-surgery hematospermia (blood in semen) and hematuria (blood in urine) can be concerning symptoms, especially after undergoing procedures such as the endoscopic removal of a polyp from the ejaculatory duct. It is essential to understand the potential causes of these symptoms and the recovery process to ensure proper healing and address any underlying issues.

In your case, the presence of blood in the semen and urine following the surgery may be attributed to several factors. First, the surgical procedure itself can lead to localized trauma in the area, resulting in minor bleeding that may take some time to resolve. The fact that you experienced blood in your semen and urine after the procedure, especially with a noticeable color change, suggests that there may still be residual effects from the surgery. The healing process can vary from person to person, and it is not uncommon for some bleeding to occur as the tissues recover.

The symptoms you described, such as the coffee-colored semen and the slight pain in the perineal area, could indicate that there is still some irritation or inflammation in the surgical site. The presence of small blood clots in the semen may also suggest that there are remnants of blood that have not yet been fully cleared from the reproductive tract. It is important to note that while the endoscopic examination showed normal results, the healing tissues may still be sensitive and prone to minor bleeding, especially during activities such as sexual intercourse.

Regarding your question about whether to continue resting or to expedite the clearance of residual blood, it is generally advisable to listen to your body. If you are experiencing discomfort or if the symptoms persist, it may be beneficial to take additional time to rest and allow your body to heal. Engaging in sexual activity too soon after surgery can sometimes exacerbate irritation and lead to further bleeding. It is crucial to follow your doctor's recommendations regarding the timeline for resuming sexual activity, as they have a better understanding of your specific case and the extent of the surgery performed.

If the symptoms of hematospermia and hematuria continue beyond a reasonable period or if you notice an increase in bleeding, it is essential to consult your healthcare provider. They may recommend further evaluation to rule out any other potential causes of bleeding, such as infections, additional polyps, or other abnormalities in the urinary or reproductive systems.
In summary, while it is possible that the symptoms you are experiencing are a result of the surgical procedure and the healing process, it is important to remain vigilant. Monitor your symptoms closely, and do not hesitate to reach out to your healthcare provider if you have concerns or if the bleeding persists. Adequate rest and following medical advice will be key to your recovery.

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