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Objective : To observe improvement of symptoms of haematospermia after treatment with Magnetic infra-red laser therapy (MIL-therapy) in patients ofhaematospermia with Chronic Prostatitis. Method: Observational study was done on 30 male patients with haematospermiawith CPPS or Chronic prostatitis , age range varied from30 to 60 years. The study was conducted from 2004 to 2008 in a private medical center in Dhaka city.The MIL therapy in use has a wave length of 1000Hz. The Laser beam reaches the prostate and seminal vesical with a special optic probe. In this study the prostate anad seminal vesicle was examined per rectally by doing digital rectal examination with use of gloves and gel .The treatment schedule was one treatment every two days ( treatment time of 5 to 10 minutes ,wave length 1000Hz) for a total 10 application . After 10 application patients were asked for follow-up and data were collected and analysed. Result :Among 30 patients of Haematospermia with Chronic prostatitis aged between 30-60 years with complains of blood discharge in semen were under treatment with MIL therapy . 25 patients with haematospermia were cured and 04 patients improved after laser treatment . But 01 patient found not improved on patients history. Conclusion : Complains of patients and sign -symptoms cured and improved after MIL therapy. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.170-176

Objective To report our experience in the diagnosis, minimally invasive treatment, and composition of seminal vesicle calculi (SVC). Patients and methods In the present study, we evaluated 20 patients who were admitted to our hospital from January 2013 to January 2018. All the patients were diagnosed with intractable haematospermia and SVC. The diagnosis was further confirmed by seminal vesiculoscopy. SVC were removed by basket extraction; with larger SVC fragmented by holmium laser before extraction. Scanning electron microscopy, X-ray diffraction, and infrared spectroscopy were used to determine the SVC composition. Results All operations were completed successfully without surgical complications. SVC were mostly composed of hydroxyapatite and protein, suggesting that they were produced by infections. Conclusions Seminal vesiculoscopy is a simple, minimally invasive technique that can be used for diagnostic confirmation and treatment of seminal vesiculitis with SVC. This study improves our understanding of SVC and provides a theoretical basis for the prevention of postoperative recurrence of SVC.

A 33-year-old male presented with a one-centimetre lesion at the penoscrotal junction which was excised and revealed to be an epithelioid sarcoma (ES). A wide local excision of the lesion and subsequent neoadjuvant radiotherapy followed, with transposition of the patient's testicles laterally to protect fertility. At 3-year follow-up, the patient has no local or distant recurrence but does have a low sperm count. The patient has also had intermittent haematospermia since his treatment for which a cause has yet to be identified. This case highlights that ES of the penis can be managed successfully with surgical excision and local radiotherapy.

Urethral haemangiomas are rare benign vascular tumours. They usually cause painless urethral bleeding and haematospermia. Urethroscopy is the preferred diagnostic tool, while complementary radiologic studies could describe the extension of the tumour. Treatment should be tailored to each case, considering size, location, and number of lesions. We present a case of a male patient diagnosed with urethral haemangiomas following painless spontaneous urethral bleeding associated with voiding symptoms.

Zika virus (ZIKV) is a re-emerging mosquito-transmitted flavivirus associated with congenital abnormalities in newborns and with Guillain-Barre syndrome in adults. The virus can also be sexually transmitted and can persist in the male genital tract. Studies evaluating the kinetics of ZIKV in seminal shedding of men who have been infected, as well as in animal and cellular models of infection, have shown that, in addition to the testis and epididymis, the prostate and seminal vesicles could also be involved in persistent ZIKV infection. Additionally, some studies have reported that men infected with ZIKV can present with genitourinary symptoms such as haematospermia, prostatitis, painful ejaculation, penile discharge, and oligospermia; however, little is known about the effect of ZIKV on fertility. Understanding the mechanisms that underlie persistent ZIKV infections in men is crucial to developing guidelines, effective vaccines, and therapies.

We aimed to evaluate and compare the clinical diagnostic values of magnetic resonance imaging (MRI) and ultrasound in patients with intractable haematospermia. We performed a retrospective review of 23 patients with intractable haematospermia who were diagnosed with seminal vesicle haematocele and/or calculi by transurethral seminal vesiculoscopy (TSV). Patients’ demographics, disease durations, operative times, and MRI and transrectal ultrasound (TRUS) results were recorded. McNemar's test was used to compare the positive diagnostic rates of MRI and TRUS. All patients had undergone preoperative seminal vesicle MRI and TRUS to identify the aetiology of the haematospermia. The average age and disease duration were 39.3 years and 24.1 months, respectively. The mean operative time was 81.1 min. The positive result rates for MRI and TRUS were 95.7% (22/23) and 39.1% (9/23), respectively. Compared with TRUS, MRI had a significantly higher preoperative positive diagnostic rate (p

Zinner syndrome was first described in 1914 and represents the triad of unilateral renal agenesis and ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Seminal vesicle cysts are often asymptomatic but can also present with pain, haematospermia, or other lower urinary tract symptoms. Treatment strategies include observation and surgical excision. We present the laparoscopic management of an enlarged seminal vesicle cyst, consistent with Zinner syndrome, 14 years after the initial diagnosis. A 58-year-old male patient was diagnosed with a left-sided seminal vesicle cyst while undergoing assessment for renal transplant due to progressively worsening renal function in his solitary right kidney. The otherwise asymptomatic cyst enlarged from the time of initial diagnosis in 2004 ( 11.3 cm × 9.7 cm × 13.1 cm ) to nearly double the size in 2018 ( 12.8 cm × 11.9 cm × 14.2 cm ). This cyst size ultimately precluded renal transplant, and the patient was referred for excision. Laparoscopic excision of the cyst was performed, histopathology confirmed seminal vesicle cyst tissue, and there has been no recurrence of the cyst to date. The patient remains active on the renal transplant waitlist. Zinner syndrome is a rare syndrome, with the seminal vesicle cysts being managed by observation or surgical excision. We report the longest documented observation of a seminal vesicle cyst, culminating in a safe and successful laparoscopic excision.

An adenocarcinoma of the seminal vesicle is a rare malignancy with a poor prognosis. Its symptoms are non-specific, rendering diagnosis difficult. We present the case of a 74-year-old male with haematospermia. Magnetic resonance imaging revealed a bulky tumour of the seminal vesicle infiltrating the prostate gland, bladder and rectum. A transrectal ultrasound-guided biopsy revealed an adenocarcinoma. Computed tomography revealed multiple lung metastases. The serum CA-125 level was high. Androgen deprivation therapy and chemotherapy (docetaxel) were prescribed. After 12 courses of docetaxel, the primary tumour and the lung metastases decreased in size and the serum CA-125 level returned to normal. The patient underwent total laparoscopic pelvic exenteration with placement of a neobladder. Histological examination revealed a mucinous adenocarcinoma with negative surgical margins. The patient did not receive adjuvant chemotherapy or radiation. He shows no evidence of recurrence 19 months after surgery.Das Adenokarzinom der Samenblase ist eine seltene Malignität mit schlechter Prognose. Seine Symptome sind unspezifisch, was die Diagnose erschwert. Der von uns vorgestellte Fall betrifft einen 74-jährigen Mannes mit Hämatospermie. In der Magnetresonanztomographie fand sich ein sperriger Tumor der Samenblase mit Infiltration von Prostata, Blase und Rektum. Die transrektale ultraschallgeführte Biopsie ergab ein Adenokarzinom. In der Computertomographie wurden mehrere Lungenmetastasen festgestellt. Des Weiteren wurde eine hohe Serumkonzentration von CA-125 gemessen. Dem Patienten wurden eine Androgendeprivationstherapie und eine Chemotherapie (Docetaxel) verordnet. Nach 12 Zyklen mit Docetaxel schrumpften die primären Tumor- und Lungenmetastasen und der CA-125-Spiegel normalisierte sich. Der Patient unterzog sich einer totalen laparoskopischen Beckenexenteration mit Platzierung einer Neoblase. Die histologische Untersuchung ergab ein muzinöses Adenokarzinom mit negativen Resektionsrändern. Der Patient erhielt keine adjuvante Chemotherapie oder Bestrahlung. Er zeigt 19 Monate nach der Operation keine Anzeichen eines Rezidivs.

To investigate the outcomes of transurethral seminal vesiculoscopy (TSV) for the treatment of seminal vesicle calculi (SVC), prostatic utricle calculi (PUC) and combination of them, a retrospective review on 27 patients with SVC and/or PUC who complained of intractable haematospermia was conducted. Patient demographics, disease duration, operation time, stone location and complications were recorded. The calculi in the seminal vesicle and/or prostatic utricle were removed by holmium laser lithotripsy and/or basket extraction. The stone composition was determined in 19 of 27 patients using Infrared spectroscopy. The average age and disease duration of patients were 39.4 years and 23.1 months respectively. The mean operative time was 78.5 min. We detected SVC, SVC and PUC, and PUC in 59.3% (16/27), 33.3% (9/27) and 7.4% (2/27) patients respectively. The stones were mainly composed of calcium oxalate dehydrate (COD), carbonate apatite (CA), COD and calcium oxalate monohydrate (COM), CA and magnesium ammonium phosphate, CA and COM, and COD and uric acid in 42.1% (8/19), 21.1% (4/19), 15.8% (3/19), 15.8% (3/19), 5.3% (1/19) and 5.3% (1/19) cases respectively. No intraoperative and post‐operative complications were noted. These results suggested that SVC and PUC can be diagnosed and treated using TSVs.

Primary seminal vesicle adenocarcinoma is a rare malignancy of the male genito-urinary system with only a few confirmed reported cases. Initial tissue diagnostic modality is often a core biopsy specimen. Here, we report this rare entity in a 50-year-old male, highlighting the histomorphological and immunohistochemical approach to the core biopsy specimen of the seminal vesicle mass. The patient presented with a history of haematospermia and gross haematuria for one year, and radiological workup was found to have a right seminal vesicle mass. A trans-rectal ultrasound guided core biopsy revealed a tumourous lesion with a predominant papillary architecture and cytological features of neoplasia. Based on positivity for CK7, PAX-8 and CA-125, and Ki-67 index of 30%-40% and negativity for PSA, AMACR, CK20, CDX-2, p63, GATA3, WT1 and calretinin, a diagnosis of primary seminal vesicle adenocarcinoma was offered. The diagnosis was also confirmed on the surgically resected specimen. This case depicts the approach of a pathologist to diagnose this rare entity on the core biopsy specimen and the possible differential diagnoses one must consider.

The aim of this study was to review the management of patients with symptomatic seminal vesicle calculi, from presentation and diagnosis to postoperative outcomes.A systematic review of the English literature in MEDLINE and Embase was performed, based on the following model: patients with a diagnosis of seminal vesicle calculi; all interventions considered with or without control groups with single and comparator interventions; outcomes considered were incidence, presentation, diagnostic methods and treatment. A narrative synthesis of the data was performed according to PRISMA 2009 guidelines. The study protocol was registered on PROSPERO (CRD42016032971).In total, 213 cases of seminal vesicle calculi from 37 studies were identified between 1928 and 2016. Published articles included cohort studies (16), case-control studies (two) and case reports (19). The most likely aetiology was stasis of ejaculate secondary to impaired drainage of secretions from the seminal vesicles. Transrectal ultrasound remains the primary investigation for haematospermia and painful ejaculation; however, magnetic resonance imaging seems to play an increasingly important role, especially when considering surgery. Transurethral seminal vesiculoscopy and lithotripsy is the ideal procedure for small calculi but requires surgical expertise. For larger calculi a transperitoneal laparoscopic approach is safe in the hands of experienced laparoscopic surgeons.Modern imaging techniques and cross-sectional imaging are leading to an increased number of diagnosed cases of seminal vesicle calculi. Optimal treatment depends on the stone size and burden, and centralization of services will assist in the development of specialized centres.

Introduction Haematospermia is an uncommon clinical condition that may be associated with prostate cancer. The optimal investigation of haematospermia is unknown. The aim of this study was to investigate haematospermia as a presenting symptom of significant pathology and to assess the diagnostic value of magnetic resonance imaging (MRI). Material and methods Patient and treatment parameters were collected from a practice cohort of men referred to a urology center presenting with haematospermia. We used a multivariate logistic regression model to test the independent significance of MRI in detecting prostate cancer (PCa) after adjusting for other known predictors of PCa detection. Results A total of 125 men (median age 58 years) were evaluated between 2012–2015. In the univariate and multivariate logistic regression model MRI was a significant predictor of PCa diagnosis after adjusting for age, prostate specific antigen (PSA) and digital rectal examination (DRE) results (Odds Ratio (OR) 14.15, p = 0.001). Of 107 patients who underwent MRI prostate imaging, 31 (28.9%) had reports suspicious of PCa. In 26 patients, other benign conditions were detected on MRI. PCa was detected in 12 (25.5%) of the 47 men (median age 61 years; range 43 to 85) who underwent prostate biopsies. Eight (17%) of these patients had Gleason ≥7 grade cancer. The persistence of haematospermia was not an independent predictor of cancer diagnosis (OR 0.20, p = 0.15). Conclusions PCa is not commonly associated with haematospermia. MRI seems to be improving detection rate of a significant PCa, particularly in patients presenting with haematospermia and normal PSA levels and DRE examination. Duration of haematospermia does not predict the presence of PCa.

Seminal Vesicle (SV) calculi are a rare pathology. Clinical presentation usually consists of nonspecific perineal pain and haematospermia. Adjuncts to aid diagnosis include US, MRI, and Vesiculography. This rare condition can be treated conservatively, however, surgical options are becoming more advanced with Vesiculoscopy now being the gold standard. Here, we present a case of a SV calculi treated conservatively.

Inverted Y malformation is a rare variant of ureteral duplication with a marked female predominance. We describe a case of inverted Y ureteral duplication with concurrent ectopic ureteral insertion into a seminal vesicle cyst, a ureterocoele and renal dysgenesis, which occurred in a 29-year-old man with lower urinary tract symptoms, haematospermia and postcoital discomfort. To our knowledge, this is the first reported case with this constellation of urogenital abnormalities.

To compare the clinical features of seminal vesicle calculi(SVC) versus posterior urethral haemangioma(PUH) to assist urologists in differentiating and diagnosing the causes of haematospermia. Patients with SVC or PUH were included. Patient age, disease duration, hospital stay, operation time, symptoms, surgical approach, pathological results and postoperative complications were recorded. A total of seven patients with SVC and 15 patients with PUH involved have an average age of 34.1 and 44.5 years separately. Patients with SVC complained of recurrent haematospermia; patients with PUH complained of recurrent haematospermia and urethral opening bleeding after sexual arousal. SVC manifested as a dark red blood-semen mixture with ejaculation pain and no blood clots; the condition could improve after anti-infective treatment. PUH manifested as no visible blood-semen mixture, bright red semen with blood clots and no ejaculation pain; the condition did not respond to anti-infective treatment. SVC was treated with holmium laser lithotripsy under a transurethral seminal vesiculoscopy. PUH was treated with transurethral resection and fulguration. Postoperative follow-up showed that the clinical symptoms gradually disappeared, with no postoperative complications. Both SVC and PUH can result in recurrent haematospermia. Therefore, urologists should treat haematospermia differently according to the cause.

Introduction Haematospermia is an uncommon clinical condition that may be associated with prostate cancer. The optimal investigation of haematospermia is unknown. The aim of this study was to investigate haematospermia as a presenting symptom of significant pathology and to assess the diagnostic value of magnetic resonance imaging (MRI). Material and methods Patient and treatment parameters were collected from a practice cohort of men referred to a urology center presenting with haematospermia. We used a multivariate logistic regression model to test the independent significance of MRI in detecting prostate cancer (PCa) after adjusting for other known predictors of PCa detection. Results A total of 125 men (median age 58 years) were evaluated between 2012-2015. In the univariate and multivariate logistic regression model MRI was a significant predictor of PCa diagnosis after adjusting for age, prostate specific antigen (PSA) and digital rectal examination (DRE) results (Odds Ratio (OR) 14.15, p = 0.001). Of 107 patients who underwent MRI prostate imaging, 31 (28.9%) had reports suspicious of PCa. In 26 patients, other benign conditions were detected on MRI. PCa was detected in 12 (25.5%) of the 47 men (median age 61 years; range 43 to 85) who underwent prostate biopsies. Eight (17%) of these patients had Gleason ≥7 grade cancer. The persistence of haematospermia was not an independent predictor of cancer diagnosis (OR 0.20, p = 0.15). Conclusions PCa is not commonly associated with haematospermia. MRI seems to be improving detection rate of a significant PCa, particularly in patients presenting with haematospermia and normal PSA levels and DRE examination. Duration of haematospermia does not predict the presence of PCa.

Infertility is the failure to conceive after regular unprotected sexual intercourse for at least 1 year. Male factor infertility is responsible for an estimated 25% of all cases of couple infertility. Azoospermia is found in approximately 15–20% of infertile men. The causes of azoospermia can be divided into obstructive and non-obstructive. Obstructive azoospermia (OA) may be due to an obstruction at any point along the male reproductive tract. It is usually associated with normal sized testis and hormonal profile, with dilatation of the epididymis. A past history of a vasectomy, inguinal hernia repair or symptoms of haematospermia with ejaculatory pain all suggest a possible cause of obstructive azoospermia.

Background Prostatic artery embolization (PAE) has been proved effective in the treatment of lower urinary tracts (LUTS) secondary to benign prostatic hyperplasia (BPH) with low complications, and most of the them are due to non-target embolization of adjacent organs, such as bladder, rectum, seminal vesicles and penis. Aim of this study was to present seminal vesicle (SV) abnormalities following prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia. Methods We reviewed 139 BPH patients who received PAE during the period of February 2009 and January 2015 at a single institution, highlighting seminal vesicle abnormalities and their clinical relevance after PAE. PAE was performed using 90~ 180-μm (mean 100-μm) polyvinyl alcohol foam particles. Results Nine of 139 patients with SV abnormalities (6.5%) were identified by magnetic resonance imaging (MRI), including subacute haemorrhage in 3 patients and ischaemia in 6 patients. Using cone-beam computed tomography (CB-CT), the seminal vesicle arteries were identified 8 of the 9 patients. All 9 patients complained of a few episodes of mild haematospermia during the 1–4 weeks after PAE; the haematospermia disappeared spontaneously without any treatment. Conclusion SV haemorrhage and ischaemia may occur after PAE, and these patients may present with transient and self-limited haematospermia.

Schistosomiasis affects more than 240 million people worldwide, an infection which may cause urogenital manifestations including, among others, squamous bladder cancer and prostate involvement. We describe the first case of a prostate adenocarcinoma associated with prostatic Schistosoma haematobium infection occurring in Angola. Prostate carcinoma was suspected because of high levels of prostate-specific antigen. This observation prompted us to review the literature on schistosomiaisis with respect to genital pathology and prostate cancer. Described genital manifestations in men include funiculitis, epididymitis, granulomata of the seminal vesicles, testicular masses, and prostate lesions which may cause haematospermia and infertility. In contrast to bladder cancer, only 12 reports including the present case on 17 cases on prostate carcinoma associated with schistosomiasis have been published worldwide. The rarity of reports on prostate carcinoma associated with schistosomiasis is partly due to diagnostic constraints, and its incidence is underestimated. However, in emerging countries, the incidence of prostate cancer appears to increase mainly as a result of urbanization and improved access to health care where schistosomiasis prevalence is decreasing.

Haematospermia (or haemospermia) is a distressing symptom in sexually active men. In most cases, it is caused by non-specific inflammation of the prostate and seminal vesicles. In a small percentage of men, however, it may be a manifestation of genito-urinary or systemic malignancy, in particular prostate cancer. The purpose of this review is to explain the causes and management of patients with haematospermia.

To prospectively monitor Zika viral loads in semen from Belgian travellers with confirmed Zika virus infection, who returned from the Americas during the 2016 Zika virus epidemic.We recruited symptomatic travellers consulting our clinic and we confirmed infection with either reverse-transcriptase (RT) polymerase chain reaction (PCR) assay or virus neutralization test. The participants produced semen samples weekly, either at the clinic or at home. For the initial sample, the laboratory staff did a microscopy analysis if they received the sample within an hour of production. Using RT-PCR, we monitored Zika virus ribonucleic acid (RNA) loads in semen until we obtained two negative results.We detected Zika virus RNA in nine of 15 participants' semen, one of whom was vasectomized. The median time to loss of RNA detection in semen was 83 days after symptom onset (95% confidence interval, CI: 57-108). The longest duration of viral shedding in semen before obtaining the first negative RT-PCR result was 144 days after symptom onset. All of the 11 participants, for whom we microscopically analysed their semen, had presence of leukocytes, 10 showed haematospermia and six showed oligospermia. These abnormalities occurred irrespective of Zika virus detection in semen.The majority of men in our study had detectable Zika virus RNA in their semen. We recommend that semen from Zika virus-infected men should be analysed with RT-PCR and that health professionals should advise infected men, even if they are vasectomized, about current recommendations for prevention of sexual transmission of the virus.Assurer un suivi prospectif des charges virales du virus Zika dans le sperme de voyageurs belges dont l'infection à virus Zika a été confirmée et qui sont rentrés du continent américain lors de l'épidémie du virus Zika de 2016.Nous avons recruté des voyageurs symptomatiques qui se sont rendus dans notre centre de consultation et avons confirmé l'infection à l'aide d'un test basé sur l'amplification en chaîne par polymérase après transcription inverse (RT-PCR) ou d'un test de neutralisation du virus. Les participants ont produit un échantillon de sperme par semaine, chez eux ou dans le centre. Pour le premier échantillon, le personnel de laboratoire a procédé à une analyse au microscope si l'échantillon était fourni dans l'heure de production. À l'aide d'une RT-PCR, nous avons suivi les charges d'acide ribonucléique (ARN) du virus Zika dans le sperme jusqu'à l’obtention de deux résultats négatifs.Nous avons détecté l'ARN du virus Zika dans le sperme de 9 des 15 participants, l'un d'entre eux ayant subi une vasectomie. Le délai médian pour que l'ARN ne soit plus détecté dans le sperme était de 83 jours après l'apparition de symptômes (intervalle de confiance, IC, à 95%: 57-108). La plus longue durée d'excrétion virale dans le sperme avant l'obtention du premier résultat négatif de la RT-PCR était de 144 jours après l'apparition de symptômes. La présence de leucocytes a été détectée chez les 11 participants dont nous avons analysé le sperme au microscope; dix d'entre eux souffraient d'hématospermie et six d'oligospermie. Ces anomalies peuvent survenir indépendamment de la présence du virus Zika dans le sperme.Nous avons détecté l'ARN du virus Zika dans le sperme de la majorité des hommes de notre étude. Nous recommandons que le sperme des hommes infectés par le virus Zika soit analysé à l'aide d'une RT-PCR et que les professionnels de santé communiquent les recommandations actuelles concernant la prévention de la transmission du virus par voie sexuelle aux hommes infectés, y compris ceux ayant subi une vasectomie.Supervisar de forma prospectiva las cargas víricas del Zika en el semen de viajeros belgas con una infección confirmada del virus del Zika, que regresaban del continente americano durante la epidemia del virus del Zika de 2016.Reclutamos a viajeros sintomáticos que consultaban nuestra clínica y confirmamos la infección con las pruebas de reacción en cadena de la polimerasa de transcriptasa inversa (RT-PCR) o con la prueba de neutralización del virus. Los participantes produjeron muestras de semen de forma semanal, en la clínica o en sus casas. Para la muestra inicial, el personal del laboratorio realizaba un análisis de microscopio si recibía las muestras durante la hora de producción. Usando la RT-PCR, supervisamos las cargas de ácido ribonucleico (RNA) del virus del Zika en el semen hasta que obtuvimos dos resultados negativos.Detectamos RNA del virus del Zika en el semen de nueve de quince de los participantes, uno de los cuales se había hecho una vasectomía. El promedio de tiempo hasta la detección de pérdida de RNA en el semen fue de 83 días tras el comienzo de los síntomas (intervalo de confianza (IC) del 95%: 57−108). El periodo máximo de eliminación del virus en el semen antes de obtener el primer resultado negativo de la RT-PCR fue de 144 días tras el comienzo de los síntomas. Los once participantes cuyo semen se analizó con el microscopio presentaron leucocitos, diez de ellos mostraron hematospermia y seis oligospermia. Estas anomalías se produjeron independientemente de la detección del virus del Zika en el semen.La mayoría de los hombres del estudio tenían RNA del virus del Zika detectable en el semen. Se recomienda que el semen de los hombres infectados por el virus del Zika se analice con RT-PCR y que los profesionales de la salud aconsejen a los hombres infectados, incluso si se han hecho la vasectomía, sobre las recomendaciones actuales para la prevención de la transmisión sexual del virus.إجراء رصد تنبؤي لحمل فيروس زيكا في السائل المنوي لدى المسافرين البلجيكيين الذين تأكدت إصابتهم بعدوى فيروس زيكا والعائدين من الأمريكيتين خلال عام 2016 حينما انتشر وباء فيروس زيكا بالمنطقة.استعنا بمسافرين ظهرت لديهم أعراض المرض، مع استشارة العيادة الطبية التابعة لنا وتأكدنا من إصابتهم بالعدوى إما من خلال تحليل تفاعل البوليميراز المتسلسل (PCR) والمستنسخة العكسية (RT) أو اختبار تحييد الفيروس. وكان المشاركون ينتجون عينات من السائل المنوي أسبوعيًا، إما في العيادة الطبية أو في منازلهم. وكان العاملون في المختبر يجرون تحليلاً بالمجهر للعينة الأولية في حالة استلامها خلال ساعة من إنتاجها. وقد رصدنا كميات حمل فيروس زيكا اعتمادًا على الحمض النووي الريبوزي (RNA) في السائل المنوي باستخدام تفاعل البوليميراز المتسلسل والمستنسخة العكسية (RT–PCR) حتى حصلنا على نتيجتين سلبيتين.اكتشفنا وجود الحمض النووي الريبوزي (RNA) في تسع عينات من بين 15 عينة من السائل المنوي للمشاركين، حيث كانت إحدى الحالات قد خضعت لجراحة قطع القناة المنوية. وكان متوسط الفترة الزمنية التي مرت لحين الكشف عن خلو السائل المنوي من الحمض النووي الريبوزي (RNA) قد بلغ 83 يومًا بعد ظهور العرض (بنسبة أرجحية مقدارها 95‏%: 57-108). وبلغت أطول مدة لإفراز الفيروس في السائل المنوي قبل الحصول على أول نتيجة سلبية لتفاعل البوليميراز المتسلسل والمستنسخة العكسية (RT–PCR) 144 يومًا بعد ظهور العرض. وقد ظهرت كرات دم بيضاء في العينات الخاصة بجميع المشاركين الذين أجرينا تحليلاً بالمجهر للسائل المنوي لهم والبالغ عددهم 11 مشاركًا، وظهرت كذلك لدى 10 منهم علامات الإصابة بتدمي المني، بينما ظهرت لدى ستة منهم علامات الإصابة بنقص الحيوانات المنوية. ولم يتم الربط بين ظهور تلك الحالات من الخلل واكتشاف فيروس زيكا في السائل المنوي لديهم.إن معظم الرجال المشاركين في الدراسة التي أجريناها قد ظهر في السائل المنوي لديهم الحمض النووي الريبوزي (RNA) لفيروس زيكا على نحو يمكن اكتشافه. ونوصي بوجوب تحليل السائل المنوي للرجال المصابين بعدوى فيروس زيكا باستخدام تفاعل البوليميراز المتسلسل والمستنسخة العكسية (RT–PCR)، ونوصي أيضًا بوجوب تقديم النصيحة للرجال المصابين بالعدوى من جانب المختصين في مجال الصحة – حتى إذا كان المصابون قد خضعوا لجراحة قطع القناة المنوية – وذلك بشأن التوصيات المتوفرة حاليًا للوقاية من انتقال الفيروس بالاتصال الجنسي.旨在对精液中携带寨卡病毒的比利时旅客进行前瞻性监测。这些旅客在 2016 年寨卡病毒流行期间从美洲返回比利时，被确诊携带寨卡病毒。.我们通过咨询诊所招募有症状的旅客，同时我们通过逆转录-聚合酶链反应 (RT–PCR) 分析或者病毒中和测试，确认感染。参与者每周在诊所或者在家提供一次精液样本。对于初始样本，实验室工作人员若在一小时之内获取样本，即对其进行显微分析。我们使用逆转录-聚合酶链反应 (RT–PCR) 方法对精液携带的寨卡病毒核糖核酸 (RNA) 进行了监测，两次监测，结果均显示阴性。.在 15 名参与者中，我们发现 9 名参与者的精液中有寨卡病毒核糖核酸 (RNA)，其中一名参与者做过输精管结扎手术。精液中核糖核酸 (RNA) 检测量平均减少时间是症状发作后 83 天（95% 的置信区间，CI: 57?108）。在获得首个阴性逆转录-聚合酶链反应 (RT–PCR) 结果之前，精液中病毒脱落的最长持续时间为症状发作后 144 天。在我们对其精液进行显微分析的 11 名参与者中，全部精液都存在白细胞，10 例呈现血精，6 例呈现精子减少。无论在精液中是否检测出寨卡病毒，均出现这些异常情况。.在我们的研究中，我们在大多数男性的精液中检测到了寨卡病毒核糖核酸 (RNA)。我们建议应该使用逆转录-聚合酶链反应 (RT–PCR) 方法分析寨卡病毒感染者的精液。医护专业人员应该向男性感染者（即使是做过输精管结扎手术的男性）提供关于预防病毒通过性行为传播的建议。.Провести проспективный мониторинг вирусной нагрузки в сперме у бельгийских путешественников с подтвержденной вирусной инфекцией Зика, которые вернулись из Северной и Южной Америки во время эпидемии вируса Зика 2016 года.К исследованию были привлечены путешественники с клиническими симптомами, консультирующиеся в нашей клинике, и наличие инфекции у них было подтверждено с помощью метода полимеразной цепной реакции (ПЦР) с обратной транскриптазой (ОТ) или теста на реакцию нейтрализации вируса. Еженедельно в клинике или на дому у участников получали образцы спермы. Сотрудники лаборатории проводили микроскопический анализ исходного образца, если этот образец был ими получен в течение часа после отбора. С помощью метода ОТ-ПЦР мы контролировали нагрузку рибонуклеиновой кислоты (РНК) вируса Зика в сперме до получения двух отрицательных результатов.Мы обнаружили РНК вируса Зика в девяти из 15 образцов спермы участников, один из которых был вазэктомизирован. Среднее время потери обнаружения РНК в сперме составляло 83 дня после начала проявления симптомов (95%-й доверительный интервал, ДИ: 57–108). Самая длинная продолжительность выделения вируса в сперме до получения первого отрицательного результата ОТ-ПЦР составила 144 дня после начала проявления симптомов. У всех 11 участников, для которых мы провели микроскопический анализ спермы, в образцах были обнаружены лейкоциты, у 10 из них — гематоспермия, а у шести — олигоспермия. Эти патологии встречались независимо от обнаружения вируса Зика в сперме.У большинства мужчин в ходе нашего исследования в сперме была обнаружена РНК вируса Зика. Рекомендуется использовать метод ОТ-ПЦР для анализа спермы, полученной от зараженных вирусом Зика пациентов, а также проводить силами медицинских работников консультации для инфицированных мужчин, даже подвергнутых вазэктомии, относительно текущих рекомендаций по профилактике половой передачи вируса.

A 65 year old gentleman was referred with symptoms of haematuria and haematospermia in association with an elevated prostate specific antigen (PSA). He was investigated with a flexible cystoscopy, Ultrasound scan and a computed tomography (CT) of his abdomen and pelvis. These failed to reveal any abnormality. Magnetic resonance imaging (MRI) revealed a Prostate Imaging Reporting and Data System PIRADS 2 lesion in the left peripheral gland and PIRADS 3 lesion on the right side posterolaterally at the level of mid gland of the prostate. He went on to have Transrectal ultrasound biopsies of his prostate (TRUS Bx) that excluded any pathology. On follow up visits his PSA continued to rise and he underwent Template biopsies of the prostate. The histological features had no evidence of any Prostatic intraepithelial carcinoma (PIN) or other malignancies. Flexible cystoscopy was repeated due to his persistent haematospermia. This showed prominent papillary lesions over his verumontanum and prostatic urethra. Biopsies from these areas revealed Ductal Adenocarcinoma of the Prostate (DACP). A subsequent staging MRI revealed unchanged appearance of the PIRADS2 nodule. There was however some low signal extending into the right seminal vesicle which is more pronounced than on the previous scan reported as PIRADS3. Subsequent mapping Template biopsies and Transurethral biopsies revealed a Gleason 4+4 DCAP. A staging CT and bone scan excluded any metastasis. He went on to receive an open radical prostatectomy and pelvic lymph node dissection as a curative treatment for his locally advanced disease.

Summary To analyze the pathogenesis of persistent and refractory haematospermia and to evaluate the aetiological diagnostic value of magnetic resonance imaging (MRI) for this type of haematospermia. Clinical data from 102 patients with persistent and refractory haematospermia was retrospectively analysed. Data collected included history, symptoms, as well as ultrasound and MRI of the morphological features of the bilateral seminal vesicles (SV) and ejaculatory duct (ED) areas. Criteria for inclusion were haematospermia symptoms that occurred more than six times, that lasted more than 6 months, and that did not improve after >1 month of conservative treatment. Patients underwent seminal vesiculoscopy with a post-surgery follow-up of 3–48 months [average (18.1 ± 10.3) months]. Of the 102 patients that underwent MRI examination, data from 88 patients (86.3%) showed typical and characteristic changes in the ED area, including the signal intensity changes in 60 (58.8%), SV volume changes in 32(31.4%), the formation of cysts such as prostatic utricular cysts in 27 (26.5%), Mullerian cysts in 4 (3.9%), ED cysts in 5 (4.9%) and a SV cyst in 1(1.0%). The MRI findings were confirmed by seminal vesiculoscopy and all patients received appropriate treatment. In 14 patients (13.7%), no obvious abnormal changes were observed with MRIs, however, these patients were diagnosed and successfully managed using seminal vesiculoscopy. Some degrees of ED obstruction was usually found during surgery. The symptoms of haematospermia disappeared 1–2 months after surgery in all patients. Two patients had a recurrence of haematospermia, underwent the same treatment, and recovered during the follow-up period. The aetiology of the most cases of the refractory haematospermia can be distinguished using the three-dimensional MRI. Typical abnormalities observed on MR images are signal intensity, SV volume changes and cyst formation. MRI has significant etiological diagnostic value and provides reliable information for the subsequent treatment of patients with persistent and refractory haematospermia.

Background and aims The optimum investigation of haematospermia is unknown. The association of this condition in relation to pathology and in particular prostate cancer is controversial and there is a paucity of evidence based literature regarding the above. The aim of this study was to investigate haematospermia as a presenting symptom of significant underlying pathology and to assess the diagnostic value of routine urological investigations. Methods 300 consecutive patients referred from primary care to a tertiary urology referral centre presenting with haematospermia were included in this observational case series. Data on patient age, concurrent presenting symptoms and urological history were collected. Subsequent patient investigations and final diagnoses were recorded. PSA and digital rectal examination (DRE) findings were noted in the over 40 age group. Results Of 469 investigative episodes, comprising: 206 flexible cystoscopies, 232 renal ultrasounds, 16 intravenous urograms (IVUs) and 15 scrotal ultrasounds; only 2 (0.4%) resulted in findings of significant new pathology which required surgical intervention. 13 prostate cancers were detected (5.7%) and 2 of dysplasia, all in men over 40 years either with a PSA of >3.0 ng/dl or an abnormal DRE. Conclusions PSA measurement and a DRE should be carried out in patients over the age of 40 years presenting with haematospermia to screen for prostate cancer. Investigation of haematospermia in the form of flexible cystoscopy, ultrasound or IVU has a very poor diagnostic yield and is not recommended routinely for an initial presentation of haematospermia.

Aim To determine whether patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy with increased sampling numbers are more likely to experience bleeding complications and whether warfarin or low-dose aspirin are independent risk factors. Materials and methods 930 consecutive patients with suspected prostatic cancer were followed up after biopsy. Warfarin/low-dose aspirin was not stopped prior to the procedure. An eight to 10 sample regime TRUS-guided prostate biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Results 902 patients returned completed questionnaires. 579 (64.2%) underwent eight core biopsies, 47 (5.2%) underwent nine, and 276 (30.6%) underwent 10. 68 were taking warfarin [mean international normalized ratio (INR) = 2.5], 216 were taking low-dose aspirin, one was taking both, and 617 were taking neither. 27.9% of those on warfarin and 33.8% of those on aspirin experienced haematuria. 37% of those on no blood-thinning medication experienced haematuria. 13.2% of those on warfarin and 14.4% of those on aspirin experienced rectal bleeding. 11.5% of those on no blood-thinning medication experienced rectal bleeding. 7.4% of those on warfarin and 12% of those on aspirin experienced haematospermia. 13.8% of those on neither experienced haematospermia. Regression analysis showed a significant association between increasing sampling number and occurrence of all bleeding complication types. There was no significant association between minor bleeding complications and warfarin use; however, there was a significant association between minor bleeding complications and low-dose aspirin use. There was no severe bleeding complication. Conclusion There is an increased risk of bleeding complications following TRUS-guided prostate biopsy with increased sampling numbers but these are minor. There is also an increased risk with low-dose aspirin use; however, there is no increased risk of bleeding complications with warfarin use. These results suggest that up to 10 cores during prostate biopsy remains acceptable safe practice and cessation of warfarin and low-dose aspirin is usually not necessary.