Arterial bleeding in patients with intractable hematospermia and concomitant hematuria: a preliminary report

To assess the presence of arterial bleeding and its outcome after transcatheter arterial embolization (TAE) in patients with intractable hematospermia and concomitant hematuria.

In a 32-month period, 5 patients with hematospermia and concomitant hematuria who were unresponsive to medical treatment were enrolled in this study to undergo pelvic angiography. When angiography revealed arterial bleeding, TAE was done whenever possible to stop the bleeding. All patients were then followed up at the outpatient clinics by the referring urologists for the result of TAE on hematospermia and the presence of impotence.

Arterial bleeding mainly from the internal pudendal artery was revealed by angiography in all 5 patients. The cessation of bleeding by TAE was successfully achieved in all patients. Hematospermia was improved in 3 patients. In the other 2 patients, hematospermia subsided after TAE but recurred at 12 and 23 months. Subsequent angiography of the 2 patients showed recurrent arterial bleeding, fed by blood flow from the opposite side. One of the 2 patients agreed to undergo a second TAE, after which the hematospermia disappeared. None of the 5 patients had impotence at follow-up.

Patients with intractable hematospermia and concomitant hematuria may have arterial bleeding that can be detected by angiography. The cessation of the bleeding could be achieved by TAE without complication of impotence. However, long-term follow-up is necessary for possible reconstitution of blood flow from the opposite side.