Hematospermia is defined as blood in the semen. While often perceived as a symptom of little significance, blood in the ejaculate can cause great concern to the men who experience it. The condition is common, and many episodes go unnoticed; therefore, the prevalence of hematospermia remains unknown. In most patients with hematospermia, the condition is self-limited and no further diagnostic workup is needed; however, in some patients, hematospermia may be the first indicator of other urologic diseases.

Hematospermia has been written about for centuries. Hippocrates, Galen, Pare, Morgagni, and Fournier all commented on this condition. The first American report appeared in 1894, and Fletcher,[1] Leary,[2] Marshall,[3] and Ganabathi[4] have subsequently published excellent contemporary reviews on the subject.

The advent of newer imaging modalities has altered both the diagnosis and the treatment of hematospermia. Aslam et al have developed an algorithm to guide the management of these patients.[5]


For an understanding of the causes of hematospermia, a working knowledge of the relevant anatomy of the ejaculatory complex is useful.

The seminal vesicles are androgen-dependent accessory organs that produce and store seminal fluid, which is essential to male fertility. The seminal vesicles are best studied ultrasonographically. Normal seminal vesicles are flat paired structures that lie cephalad to the prostate behind the bladder and have a bow-tie appearance on transverse imaging. They are symmetric, well-defined, saccular, elongated organs. In its normal collapsed state, the center of the gland is homogenous, with areas of increased echogenicity corresponding to the folds of secretory epithelium. In the distended state, the wall is visibly composed of 2 distinct layers. Caudally, the seminal vesicles diverge laterally.

The dimensions of the seminal vesicles vary with age, but not with the ejaculatory state. Upon transrectal ultrasonography (TRUS), the dimensions are estimated to be 30 ± 5 mm in length, 15 ± 4 mm in width, and 13.7 ± 3.7 mL in mean volume. The age of the patient and degree of prostate enlargement have been shown to cause variation in the size of the seminal vesicles.

MRI findings may also help delineate the normal anatomy of the seminal vesicles. Using MRI, the signal intensity of the seminal vesicles can be compared with the tissues surrounding them (ie, skeletal muscle, fat, urine). The signal intensity on T1-weighted spin-echo images of normal seminal vesicles in men is similar to or slightly higher than that of skeletal muscles and is always greater than that of urine. On T2-weighted images, the signal intensity varies. In prepubertal boys and men older than 70 years (androgen-deprived males), the signal intensity is generally lower than that of skeletal muscle or urine. Convolutions of the seminal vesicles are best observed on T2-weighted images or on T1-weighted images with the use of intravenous contrast agents.

The vasa deferentia act as conduits, carrying sperm between the epididymis and the ejaculatory ducts via the vasal ampullae. The vasal ampullae pass medially to the seminal vesicles and are best seen using transaxial TRUS views.

The seminal vesicles and vasal ampullae join together to form the ejaculatory duct. The ejaculatory duct travels through the prostate and enters the urethra at the level of the verumontanum. The junction between the seminal vesicle and the ejaculatory duct lies within the prostate and is difficult to see in a healthy unobstructed system. Small echodensities are frequently seen at the junction of the ejaculatory ducts and the verumontanum in the urethra. These areas provide useful landmarks and are thought to represent concretions within the periurethral glands surrounding the verumontanum.



United States

The true prevalence of hematospermia is unknown. It is likely that many cases escape the patient's notice, and remain unrecognized and unreported.

Data collected after TRUS-guided biopsy of the prostate suggest that up to 36.3% of men undergoing 6-15 cores develop postprocedure hematospermia. Increasing the number of cores did not significantly increase the frequency of hematospermia.[6]


Hematospermia can occur in males of any age. In younger men (< 40 y), hematospermia is uniformly benign. Even in older men, it is rarely associated with malignancy.


A good patient history that concentrates on pelvic instrumentation, trauma, infection, and bleeding disorders often helps to narrow the differential diagnoses associated with hematospermia.

Most patients have more than one episode, occurring over weeks to months. While no uniformly accepted definition of chronic hematospermia has been determined, blood in the ejaculate that persists for more than 10 ejaculations requires further evaluation. While some authorities use duration (ie, months) as a guideline, the discrepancy in the frequency of ejaculations among men renders this approach less reliable.

Patient age is important. In patients younger than 40 years, urogenital infections are the most common cause of hematospermia, and a simple, focused workup is often sufficient. In men older than 40 years with persistent hemospermia or associated symptoms such as hematuria, excluding urogenital malignancy is essential[3]


The physical examination should include measuring the patient's blood pressure, because severe hypertension is associated with hematospermia. This association is well recognized; however, the exact mechanism by which it occurs is unclear. It may have a similar basis to the association of hypertension with epistaxis (nosebleeds).

Consider the following in the genital examination:


Hematospermia is usually associated with inflammatory conditions of the seminal vesicles or prostate. The condition is often self-limited and resolves within 1-2 months. If hematospermia persists beyond 2 months, further workup is recommended to determine the cause. In approximately half the cases, the etiology is declared idiopathic. However, this may reflect an incomplete evaluation.

Conditions of the prostate

Lesions of the prostate account for many cases of hematospermia. The most common etiology is prostate biopsy, which produces self-limited hematospermia that resolves within approximately 1 month. In one case series, prostatitis was cited as the etiology in 30% of the patients.

Other authors have recognized prostate cancer as an etiologic factor. Malignancies account for 2% of cases. In a long-term follow-up study of 150 patients with hematospermia, only six patients eventually developed prostate carcinoma, and none had prostate carcinoma diagnosed at the time of the initial evaluation.

However, a study by Han et al reported a significantly increased risk of prostate cancer among men with hematospermia. Of 139 men with hematospermia, 19 (13.7%) were diagnosed with prostate cancer. In the overall cohort of 26,126 patients, the prostate cancer detection rate was 6.5%. On logistic regression analysis, the presence of hematospermia was a significant predictor of prostate cancer diagnosis.[7]

This is still a controversial area of investigation. Prando reported on a series of 86 men with hemospermia and found prostate cancer in only one patient.[8] In a review by Ng et al of 300 consecutive cases of hematospermia, 13 prostate cancers were detected (5.7%), all in men over 40 years of age with either with a prostate-specific antigen (PSA) level of >3.0 ng/dL or an abnormal digital rectal examination (DRE). Those researchers recommended screening for prostate cancer in men over 40 who present with hematospermia.[9]

Hematospermia can also be caused by prostatic telangiectasia and varices. In rare cases, a patient with hematospermia may be diagnosed with prostatic varices only after cystoscopic examination while the patient has an erection. In order to diagnose this condition, flexible (preferably) or rigid cystoscopy is conducted after pharmacological induction of an erection.

Prostatitis is often thought to cause hematospermia, although no specific association has been reported. Upon signs and symptoms of acute bacterial prostatitis, specific treatment is indicated. If symptoms of chronic pelvic pain prostatitis syndrome are present, urine culture and then culture of expressed prostatic secretions should be performed. Hematospermia is not a recognized symptom of chronic prostatitis syndrome.

In a study of 52 patients with hematospermia, Etherington et al found a significant number of patients with prostatic calculi.[10]

Another publication reported on cystic dilation of the prostatic utricle in association with hematospermia. Furuya and Kato reported on 30 of 138 men with hematospermia who had a midline cyst of the prostate. Nineteen men underwent transperineal biopsy; hemorrhagic fluid was confirmed in 13 of the men. Four of the men were cured with transurethral unroofing.[11]

With the advent of TRUS-guided prostate biopsy for the diagnosis of prostate cancer, a new etiology of hematospermia has emerged. Many centers have reviewed their experience with this complication.[12]

The rate of hematospermia following transrectal biopsy of the prostate has varied from 9-45%. In one study, 25% of patients who underwent TRUS biopsy had concomitant hematospermia and hematuria after the procedure. Berger et al reported on 5957 biopsies performed in 4303 men. This group found that hematospermia occurred after approximately 36% of the biopsies. They concluded that, in this situation, the hematospermia is generally self-limited and requires no specific therapy.[6]

Transurethral resection of the prostate is also associated with subsequent hematospermia. A study by Shen et al described 80 consecutive men who underwent transurethral prostate resection and found that hematospermia developed in 2.5% of the men.[13]

Some authors have recommended administering finasteride beginning 2 weeks prior to TRUS biopsy of the prostate to reduce the risk of postprocedure hematuria. While no studies have specifically examined the impact of finasteride on the occurrence of hematospermia, this condition may be improved with the use of this medication.

Brachytherapy as treatment for prostate cancer involves inserting radioactive seeds directly into the prostate. This procedure has been shown to cause hematospermia in up to 17% of patients who undergo this treatment.[14]

Conditions of the urethra

Urethritis has long been recognized as a cause of hematospermia, especially in younger men.

Other urethral lesions leading to hematospermia include cysts, polyps, condylomata, and strictures. Benign urethral polyps can occur following failure of the invagination process of the prostatic glandular epithelium. In one case series, 20% of patients with urethral polyps had hematospermia as their presenting symptom. In another study, urethritis, condylomata, and stricture disease represented the cause of hematospermia in 7%, 1.5%, and 1.5% of the patients, respectively.

Seminal vesicle lesions

Many authors have cited congenital and acquired seminal vesicle cysts as a cause of hematospermia. Congenital cysts result from an error in embryological development and are associated with ipsilateral renal agenesis and/or ipsilateral congenital absence of the vas deferens.

Acquired seminal vesicle cysts generally result from infectious processes, and malignancies of the seminal vesicles are a rare cause of hematospermia. In one review of 39 patients with primary carcinoma of the seminal vesicle, only 6 patients (16%) had hematospermia.

More recently, amyloidosis of the seminal vesicles has been described to be related to hematospermia.[15] Fifty-six men with hematospermia were evaluated with MRI, and obvious intravesicular hemorrhage was associated with hyperintense signal (brighter) of the seminal vesicles on MRI. After resolution of the bleeding, the signal returned to a hypointense state (lighter) on MRI. Twelve of these patients underwent transperineal biopsy; 4 were found to have seminal vesicle amyloidosis. In all cases, hematospermia resolved with conservative intervention.

The most recent data suggest that seminal vesicle and ejaculatory duct cysts or hemorrhagic lesions account for most identifiable causes of hemospermia. Fifty-two of 86 men in a recent study were found to have lesions in association with hemospermia. Of these men, 51 had some type of seminal vesicle, ejaculatory duct, or prostatic benign or hemorrhagic lesion. Only one case of prostate cancer was identified.[8]


Infections and inflammatory disorders account for 40% of cases. Infectious causes of hematospermia include tuberculosis (TB), HIV infection, and cytomegalovirus infection. Yu and colleagues found that 11% of a cohort of 65 patients with genitourinary TB had hematospermia during their disease.[16]

A review of 16 men with hematospermia who presented to a sexually transmitted infection clinic found pathogens in 12 of the men. These included urine, genitourinary, or serum cultures or titers positive for herpes simplex virus in five, Chlamydia trachomatis in four, Enterococcus faecalis in two, and Ureaplasma urealyticum in one. Culture-specific antibiotics were administered, and hematospermia resolved in all the patients.[17]

Several authors have reported schistosomiasis as a cause of hematospermia. Although these patients often have extensive bladder involvement, Schistosoma hematobium ova are only occasionally found in the ejaculate.

Hydatid disease, a parasitic infection caused by the Echinococcus worm, has also been associated with hematospermia.


Trauma has been cited as a cause of hematospermia in several case reports. Such case reports include hematospermia occurring following hemorrhoidal sclerosing injection, urethral self-instrumentation, and testicular and perineal blunt trauma. Hematospermia following transrectal prostate needle biopsy should also be included in this category. Approximately 2% of cases are believed to result from trauma other than that related to recent prostate biopsy.

Systemic disorders

Systemic disorders that are associated with hematospermia include hypertension, chronic liver disease, amyloidosis, lymphoma, and bleeding diatheses (eg, von Willebrand disease). In one case-controlled study of patients undergoing hypertension therapy, the prevalence of hematospermia was no higher than in the general population; however, hematospermia resolved in several patients when their hypertension was controlled.

Risk factors for hematospermia in patients who are hypertensive include the following:

Kurkar and colleagues identified hyperuricemia as a possible cause of hematospermia. Compared with their patients who had idiopathic hematospermia, those with hyperuricemia (median serum uric acid level, 9.3 mg/dL) were significantly younger (median of 31.5 vs 45 years) and more likely to complain of painful ejaculation (68.2% vs 9.5%).Hematospermia resolved completely in all patients of the hyperuricemia group in 1-4 months, compared with only 25% of the idiopathic group.[18]

Approach Considerations

In younger men with nonpersistent hematospermia, only a digital rectal examination (DRE), along with a check of vital signs, is required as part of a careful physical examination. In older men (>50 y) with nonpersistent hematospermia without concomitant hematuria upon urinalysis, a basic evaluation consists of a DRE and a prostate-specific antigen measurement. Persistent hematospermia (>2 mo without defined etiology) warrants a full workup, as described below.

Urinalysis and culture

Urinalysis and culture may prove helpful because urogenital infections may be associated with hematospermia. Unfortunately, the rate of positive culture results is low, varying from 6-29%. Because this test is of low cost and a positive result suggests an etiology, urine culture is recommended in all patients who present with hematospermia.

If the history suggests exposure to tuberculosis (TB), urine culture for acid-fast bacilli may prove helpful because TB is a cause of hematospermia in as many as 13% of patients in some series.

In younger men, urethritis should be considered in the differential diagnoses, and urethral swabs should be obtained and examined to help exclude nonspecific and gonococcal urethritis.

Blood in the urine mandates a more extensive evaluation of the genitourinary tract. At the authors' institution, patients presenting with hematuria undergo the following tests:

Semen analysis and culture

The role of semen analysis and culture remains unclear. While advocated by some authors, the significance of a positive culture result remains uncertain because this may simply represent urethral contamination. Semen analysis may prove helpful in the differentiation of true hematospermia from other causes of ejaculate discoloration.

Smith et al reported two cases of melanospermia as the presenting feature of malignant melanoma.[19] Melanin produces a dark brown or black discoloration of semen rather than red or pink, which occurs with hematospermia. If necessary, the two can be differentiated based on chromatography findings. Normal semen should appear as a coagulum that liquifies over a 5- to 25-minute period.

Otherwise, laboratory analyses should be limited to an evaluation for bleeding disorders.

Blood work

Prostate-specific antigen analysis is recommended in all men older than 50 years, African American men, and men older than 40 years with a family history of prostate cancer. Hematospermia may be a harbinger of prostate cancer.

Coagulation studies are recommended in men of all ages with persistent hematospermia (>2 mo) because this condition is associated with coagulopathies.

Transrectal Ultrasonography

The advent of transrectal ultrasonography (TRUS) has provided physicians with the single most important new tool for evaluating patients with hematospermia and has relegated the role of studies such as intravenous urography, vasography, and seminal vesiculography to that of only historical interest.[20] TRUS and MRI allow clear visualization of the seminal vesicles, prostate, and ampullary portions of the vas. As a result, etiologic factors can now be identified more frequently.

TRUS is not recommended for routine use in patients initially presenting with hematospermia.[9] However, TRUS can be valuable for evaluating older patients or those with persistent hemospermia or associated symptoms.[3]

Three large series have evaluated the utility of TRUS in the investigation of patients with chronic hematospermia. In a study of 52 patients, Etherington et al found a significant number of patients with prostatic calculi and abnormalities of the seminal vesicles, including calculi, dilatation, cysts, abnormal lobulation, and asymmetry.[10]

Worischeck and Parra evaluated 26 patients with hematospermia using TRUS. They found abnormalities in 92% of patients, which included dilatated seminal vesicles (30%), ejaculatory duct cysts (15%), ejaculatory duct calculi (15%), seminal vesicle calculi (15%), and müllerian duct remnants (7%). No ultrasonographic evidence of malignancy was found.[21]

In a study by Raviv et al of 115 consecutive patients with hematospermia who were evaluated with TRUS, all the patients were found to have an abnormality, almost all of them benign. In 10 patients a 12-core TRUS-guided biopsy of the prostate was taken; none of the samples were positive for tumor.[22]

The incidence of seminal vesicle abnormalities in these series is similar to that in earlier studies that used biochemical assays and seminal vesiculography. Unfortunately, none of these studies cited the mean patient age. This factor may have aided clinicians in stratifying patients in different treatment algorithms.

Magnetic Resonance Imaging

Other Imaging Modalities

Seminal Vessel Endoscopy

Persistent hematospermia (>3 mo) without an antecedent cause or persistent hematospermia associated with an abnormality on ultrasonography or MRI may prompt further evaluation. Yang et al described a technique in which a 6F or 9F rigid ureteroscope is used to gain access to the prostatic utricle or ejaculatory ducts. In this manner, the scope is used to visually inspect the seminal vesicles, and a biopsy specimen may then be obtained from any abnormal area. In a study of this procedure by Yang et al, seminal vesicle hemorrhage was found in 62% of patients, and calculi were found in 16%.[24]

Medical Care

The primary goal in the management of hematospermia is to allay the anxiety of the frightened patient. Hematospermia is rarely associated with significant pathology, especially in younger men. The three factors that dictate the extent of the evaluation and treatment include (1) patient's age, (2) the duration and recurrence of the hematospermia, and (3) the presence of any associated hematuria. Most malignancies associated with hematospermia occur in patients older than 40 years. Chronic hematospermia warrants more aggressive intervention to identify an etiologic factor.

Urogenital infections require appropriate antibiotic therapy, which normally resolves the problem. In all men, enterobacteria (especially Escherichia coli) should be covered. In younger men, concomitant therapy for chlamydial infections should also be used. A fluoroquinolone should adequately treat both organisms. If the patient is allergic to fluoroquinolones or cannot afford this class of drugs, a combination of trimethoprim/sulfamethoxazole and doxycycline is often successful. A 2-week course is usually sufficient. Concomitant inflammation may be treated with ibuprofen or other nonsteroidal anti-inflammatory drugs.

Urethral or prostatic varices are best fulgurated, while cysts, of either the seminal vesicles or prostatic urethra, can be aspirated transrectally. Fuse and colleagues injected coagulant substances into dilatated seminal vesicles under transrectal ultrasound guidance in seven patients with hematospermia. The hematospermia was transiently resolved by this maneuver for a maximum duration of 3 months, at which time the condition recurred.[25] Therefore, currently, no evidence suggests that the injection of any substance, coagulant or sclerosant, has any role in the management of hematospermia.

Bleeding diatheses or other systemic disorders should be managed in the appropriate manner.

In men with coexisting bladder outlet obstruction, a 5-alpha reductase inhibitor may be used.

No rationale currently exists for the use of oral agents, such as estrogens or corticotrophins, which have been used in the past.

Surgical Care

Patients in whom bleeding prostatic variceal veins are suggested as the cause of hematospermia are candidates for fulguration. After infectious causes have been excluded in cases of persistent hematospermia, cystourethroscopy is performed. If large friable prostatic veins are discovered and examination findings are otherwise normal, fulguration with a Bugbee or loop electrode can be performed. Prior to fulguration, a biopsy should be performed on any suggestive lesions.

More recently, a technique of endoscopy of the ejaculatory ducts and seminal vesicles has been described.[26, 27] This technique involves using a semirigid ureteroscope to cannulate the ejaculatory duct and allows the surgeon to examine the duct, seminal vesicle, and ampulla of the vas. However, the author reserves this technique for only the most refractory cases of hemospermia that cause significant physiologic (urinary retention or persistent hematuria) or psychological (avoidance of ejaculation) trauma.

Further Outpatient Care

In the absence of recurrence, no specific follow-up for hematospermia is warranted. Chronic (>2 mo) or recurrent hematospermia should be evaluated based on the associated clinical features.



Jonathan D Schiff, MD, Assistant Clinical Professor of Urology, Department of Urology, Mount Sinai Medical Center; Adjunct Assistant Clinical Professor of Urology, Weill-Cornell School of Medicine

Disclosure: Nothing to disclose.


from Memorial Sloan-Kettering – John P Mulhall, MD, Director, Sexual and Reproductive Medicine Program, Memorial Sloan-Kettering Cancer Center

Disclosure: Nothing to disclose.

Specialty Editors

Edmund S Sabanegh Jr, MD, Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Associate Chair for Urologic Surgical Services, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Disclosure: Lilly Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Actavis Honoraria Speaking and teaching; Auxilium Honoraria Speaking and teaching


  1. Fletcher MS, Herzberg Z, Pryor JP. The aetiology and investigation of haemospermia. Br J Urol. Dec 1981;53(6):669-71. [View Abstract]
  2. Leary FJ, Aguilo JJ. Clinical significance of hematospermia. Mayo Clin Proc. Nov 1974;49(11):815-7. [View Abstract]
  3. Ahmad I, Krishna NS. Hemospermia. J Urol. May 2007;177(5):1613-8. [View Abstract]
  4. Ganabathi K, Chadwick D, Feneley RC, et al. Haemospermia. Br J Urol. Mar 1992;69(3):225-30. [View Abstract]
  5. Aslam MI, Cheetham P, Miller MA. A management algorithm for hematospermia. Nat Rev Urol. Jul 2009;6(7):398-402. [View Abstract]
  6. Berger AP, Gozzi C, Steiner H, et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. Apr 2004;171(4):1478-80; discussion 1480-1. [View Abstract]
  7. Han M, Brannigan RE, Antenor JA, et al. Association of hemospermia with prostate cancer. J Urol. 12 2004;172(6, Part 1 of 2):2189-2192. [View Abstract]
  8. Prando A. Endorectal magnetic resonance imaging in persistent hemospermia. Int Braz J Urol. Mar-Apr 2008;34(2):171-7; discussion 177-9. [View Abstract]
  9. Ng YH, Seeley JP, Smith G. Haematospermia as a presenting symptom: outcomes of investigation in 300 men. Surgeon. Feb 2013;11(1):35-8. [View Abstract]
  10. Etherington RJ, Clements R, Griffiths GJ, et al. Transrectal ultrasound in the investigation of haemospermia. Clin Radiol. Mar 1990;41(3):175-7. [View Abstract]
  11. Furuya S, Kato H. A clinical entity of cystic dilatation of the utricle associated with hemospermia. J Urol. Sep 2005;174(3):1039-42. [View Abstract]
  12. Abdelkhalek MA, Abdelshafy M, Elhelaly HA, El Nasr MK. Hemospermia after transrectal ultrasound (TRUS)-guided prostatic biopsy: a prospective study. J Egypt Soc Parasitol. Apr 2012;42(1):63-70. [View Abstract]
  13. Shen BY, Chang PL, Lee SH, Chen CL, Tsui KH. Complications following combined transrectal ultrasound-guided prostate needle biopsies and transurethral resection of the prostate. Arch Androl. Mar-Apr 2006;52(2):123-7. [View Abstract]
  14. Finney G, Haynes AM, Cross P, et al. Cross-sectional analysis of sexual function after prostate brachytherapy. Urology. Aug 2005;66(2):377-81. [View Abstract]
  15. Furuya S, Masumori N, Furuya R, et al. Characterization of localized seminal vesicle amyloidosis causing hemospermia: an analysis using immunohistochemistry and magnetic resonance imaging. J Urol. Apr 2005;173(4):1273-7. [View Abstract]
  16. Yu HH, Wong KK, Lim TK, et al. Clinical study of hemospermia. Urology. Dec 1977;10(6):562-3. [View Abstract]
  17. Bamberger E, Madeb R, Steinberg J, et al. Detection of sexually transmitted pathogens in patients with hematospermia. Isr Med Assoc J. Apr 2005;7(4):224-7. [View Abstract]
  18. Kurkar A, Elderwy AA, Awad SM, Abulsorour S, Aboul-Ella HA, Altaher A. Hyperuricemia: a possible cause of hemospermia. Urology. Sep 2014;84(3):609-12. [View Abstract]
  19. Smith GW, Griffith DP, Pranke DW. Melanospermia: an unusual presentation of malignant melanoma. J Urol. Sep 1973;110(3):314-6. [View Abstract]
  20. Xing C, Zhou X, Xin L, Hu H, Li L, Fang J, et al. Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia. Int J Urol. May 2012;19(5):437-42. [View Abstract]
  21. Worischeck JH, Parra RO. Chronic hematospermia: assessment by transrectal ultrasound. Urology. Apr 1994;43(4):515-20. [View Abstract]
  22. Raviv G, Laufer M, Miki H. Hematospermia--the added value of transrectal ultrasound to clinical evaluation: is transrectal ultrasound necessary for evaluation of hematospermia?. Clin Imaging. Sep-Oct 2013;37(5):913-6. [View Abstract]
  23. Maeda H, Toyooka N, Kinukawa T, et al. Magnetic resonance images of hematospermia. Urology. May 1993;41(5):499-504. [View Abstract]
  24. Yang SC, Rha KH, Byon SK, et al. Transutricular seminal vesiculoscopy. J Endourol. Aug 2002;16(6):343-5. [View Abstract]
  25. Fuse H, Sumiya H, Ishii H, et al. Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography. J Urol. Nov 1988;140(5):991-2. [View Abstract]
  26. Li L, Jiang C, Song C, et al. Transurethral endoscopy technique with a ureteroscope for diagnosis and management of seminal tracts disorders: a new approach. J Endourol. Apr 2008;22(4):719-24. [View Abstract]
  27. Li YF, Liang PH, Sun ZY, Zhang Y, Bi G, Zhou B, et al. Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia. J Androl. Sep 2012;33(5):906-16. [View Abstract]
  28. Ashkar MF, Issa II. Bilharzial hematospermia. J Egyp Med Assoc. 1935;18:274.
  29. Aus G, Hermansson CG, Hugosson J, et al. Transrectal ultrasound examination of the prostate: complications and acceptance by patients. Br J Urol. Apr 1993;71(4):457-9. [View Abstract]
  30. Benson RC Jr, Clark WR, Farrow GM. Carcinoma of the seminal vesicle. J Urol. Sep 1984;132(3):483-5. [View Abstract]
  31. Cattolica EV. Massive hemospermia: a new etiology and simplified treatment. J Urol. Jul 1982;128(1):151-2. [View Abstract]
  32. Close CF, Yeo WW, Ramsay LE. The association between haemospermia and severe hypertension. Postgrad Med J. Feb 1991;67(784):157-8. [View Abstract]
  33. Collins GN, Lloyd SN, Hehir M, et al. Multiple transrectal ultrasound-guided prostatic biopsies--true morbidity and patient acceptance. Br J Urol. Apr 1993;71(4):460-3. [View Abstract]
  34. Craig SR. '3-in-1' nerve block complicated by haemospermia. Br J Clin Pract. Summer 1992;46(2):80. [View Abstract]
  35. Elem B, Patil PS. Haemospermia: observations in an area of endemic bilharziasis. Br J Urol. Aug 1987;60(2):170-3. [View Abstract]
  36. Geoghegan JG, Bonavia I. Haemospermia as a presenting symptom of lymphoma. Br J Urol. Dec 1990;66(6):658. [View Abstract]
  37. Gustafsson O, Norming U, Nyman CR, et al. Complications following combined transrectal aspiration and core biopsy of the prostate. Scand J Urol Nephrol. 1990;24(4):249-51. [View Abstract]
  38. Halim A, Vaezzadeh K. Hydatid disease of the genitourinary tract. Br J Urol. Apr 1980;52(2):75-8. [View Abstract]
  39. Hamburger S, Styczynski M, O'Hearne J, et al. Hemospermia and hypertension two case reports. J Kans Med Soc. Oct 1980;81(10):459-60. [View Abstract]
  40. Heller E, Whitesel JA. Seminal vesicle cysts. J Urol. Sep 1963;90:305-7. [View Abstract]
  41. Huggins C, McDonald DF. Chronic hemospermia: its origin and treatment with estrogen. J Clin Endocrin. 1945;5:226-31.
  42. Hugues J. La pathogenia de l'hemospermia. Gaz Hebd de Med. 1894;41:113-5.
  43. Iversen PS. [Hemospermia and hypertension]. Ugeskr Laeger. Feb 23 1987;149(9):596. [View Abstract]
  44. Jones DJ. Haemospermia: a prospective study. Br J Urol. Jan 1991;67(1):88-90. [View Abstract]
  45. Kawahara M, Matsuhashi M, Tajima M, et al. Primary carcinoma of seminal vesicle. Diagnosis assisted by sonography. Urology. Sep 1988;32(3):269-72. [View Abstract]
  46. Kenney PJ, Leeson MD. Congenital anomalies of the seminal vesicles: spectrum of computed tomographic findings. Radiology. Oct 1983;149(1):247-51. [View Abstract]
  47. Koment RW, Poor PM. Infection by human cytomegalovirus associated with chronic hematospermia. Urology. Dec 1983;22(6):617-21. [View Abstract]
  48. Kotsyn I. On bloody semen. Russk Med. 1893;18:136-8.
  49. Lembeli CM, Venkataramaiah NR. Schistosoma haematobium ova in semen. J Urol. Apr 1981;125(4):603. [View Abstract]
  50. Lemesh RA. Case report: recurrent hematuria and hematospermia due to prostatic telangiectasia in classic von Willebrand's disease. Am J Med Sci. Jul 1993;306(1):35-6. [View Abstract]
  51. Littrup PJ, Lee F, McLeary RD, et al. Transrectal US of the seminal vesicles and ejaculatory ducts: clinical correlation. Radiology. Sep 1988;168(3):625-8. [View Abstract]
  52. Magid MA, Hejtmancik JH. Hematospermia. J Urol. Jul 1957;78(1):82-88. [View Abstract]
  53. Ogreid P, Hatteland K. Cyst of seminal vesicle associated with ipsilateral renal agenesis. A report on four cases. Scand J Urol Nephrol. 1979;13(1):113-6. [View Abstract]
  54. Papp G, Molnar J. Causes and differential diagnosis of hematospermia. Andrologia. Sep-Oct 1981;13(5):474-8. [View Abstract]
  55. Parker G. Hemospermia. Proc Roy Soc Med. 1942;35:659-62.
  56. Pryor JP. Hemospermia. In: Whitfield HN, Hendry WF, eds. Textbook of Genitourinary Surgery. Edinburgh, Scotland: Churchill Livingstone; 1985:1208-11.
  57. Ross JC. Haemospermia. Practitioner. Jul 1969;202(213):59-62. [View Abstract]
  58. Secaf E, Nuruddin RN, Hricak H, et al. MR imaging of the seminal vesicles. AJR Am J Roentgenol. May 1991;156(5):989-94. [View Abstract]
  59. Silverman PM, Dunnick NR, Ford KK. Computed tomography of the normal seminal vesicles. Comput Radiol. Nov-Dec 1985;9(6):379-85. [View Abstract]
  60. Stein AJ, Prioleau PG, Catalona WJ. Adenomatous polyps of the prostatic urethra: a cause of hematospermia. J Urol. Aug 1980;124(2):298-9. [View Abstract]
  61. Søndergaard G, Vetner M, Christensen PO. Prostatic calculi. Acta Pathol Microbiol Immunol Scand [A]. May 1987;95(3):141-5. [View Abstract]
  62. Tolley DA, Castro JE. Hemospermia. Urology. Sep 1975;6(3):331-2. [View Abstract]
  63. Tripathi VN, Dick VS. Primary sarcoma of the urogenital system in adults. J Urol. Jun 1969;101(6):898-904. [View Abstract]
  64. Van Poppel H, Vereecken R, De Geeter P, et al. Hemospermia owing to utricular cyst: embryological summary and surgical review. J Urol. Mar 1983;129(3):608-9. [View Abstract]
  65. Walsh IK, Keane PF, Herron B. Benign urethral polyps. Br J Urol. Dec 1993;72(6):937-8. [View Abstract]
  66. Weidner W, Jantos C, Schumacher F, et al. Recurrent haemospermia--underlying urogenital anomalies and efficacy of imaging procedures. Br J Urol. Mar 1991;67(3):317-23. [View Abstract]
  67. Whyman MR, Morris DL. Retrovesical hydatid causing haemospermia. Br J Urol. Jul 1991;68(1):100-1. [View Abstract]
  68. Widdison AD, Feneley RC. Case report: Calculi in the ejaculate. Br J Sex Med. 1989;16:270-1. [View Abstract]
  69. Yada B. On the study of hemospermia. Hinyokika Kiyo. Apr 1963;9:175-206. [View Abstract]