ACR Appropriateness Criteria^® Hematospermia

Area of Science:

• Urology
• Radiology
• Medical Imaging

Background:

• Hematospermia (HS) often affects young men (<40) and is typically transient and idiopathic.
• In older men (>40), HS warrants screening for prostate cancer.
• Persistent or symptomatic HS may indicate urogenital tract issues like strictures or calculi.

Purpose of the Study:

• To outline the diagnostic approach for hematospermia (HS).
• To define the role of imaging in evaluating HS.
• To present evidence-based guidelines for HS management.

Main Methods:

• Review of current medical literature.
• Application of RAND/UCLA Appropriateness Method and GRADE methodology.
• Expert opinion for evidence gaps.

Main Results:

• Imaging is not typically needed for young men with asymptomatic HS.
• Transrectal ultrasound (TRUS) is the first-line imaging modality for persistent or symptomatic HS.
• MRI is utilized when TRUS is inconclusive or negative.

Conclusions:

• Most HS cases in young men are self-limiting and idiopathic.
• Imaging plays a crucial role in evaluating older men or those with persistent/symptomatic HS.
• ACR Appropriateness Criteria guide imaging and treatment decisions for HS.