Transurethral incision for hematospermia caused by ejaculatory duct obstruction

Area of Science:

• Urology
• Medical Imaging

Background:

• Hematospermia, or blood in semen, is often attributed to pathologies within the seminal vesicles, prostate, testes, epididymis, or urethra.
• Recent advancements highlight the seminal vesicle, prostate, and midline cysts as potential sources of hematospermia.

Observation:

• A 51-year-old male presented with hematospermia.
• Transurethral ultrasonography revealed a cystic lesion with a hyperechoic border in the prostate.
• Vasography showed distal ejaculatory duct dilation, and MRI indicated a high signal intensity area in the prostate.

Findings:

• Urethrocystoscopy identified an enlarged cystic lesion with an opening in the prostatic urethra.
• Endoscopic incision of the cystic lesion was performed without immediate complications.
• Seven months post-procedure, the patient's hematospermia resolved completely.

Implications:

• Midline cysts should be considered a significant cause of hematospermia, potentially occurring more frequently than previously recognized.
• Transurethral endoscopic techniques offer a successful and minimally invasive treatment for hematospermia caused by ejaculatory duct obstruction due to midline cysts.