This document describes a case of recurrent hematospermia (blood in semen) in a 47-year-old male that was treated with laparoscopic excision of the left seminal vesicle. Initial conservative management and investigations revealed hemorrhage in the left seminal vesicle on MRI. The patient underwent cystoscopy, seminal vesiculoscopy, and laparoscopic excision of the left seminal vesicle. Post-operatively, the hematospermia resolved however the patient later developed a retrovesical abscess that improved with aspiration. Follow-up 8 months later showed no recurrence of symptoms and normal sexual function.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.
Decreased caliber and force of the stream
Problems starting(hesitancy) and stopping urine stream; post-void dribbling
Impaired bladder emptying
- high risk of infection and hydronephrosis
Urinary retention
Incontinence
Nocturia; polyuria / Dysuria
Hypertrophy of bladder wall muscle
- increased risk for bladder diverticula
Microscopic hematuria maybe present
An enlarged prostate is the slow growth of the prostate gland, which is involved in the production of seminal fluid and reproductive function in men. The prostate wraps around the tube that transports urine out of the bladder. It is very common for the prostate gland to become enlarged as a man ages. An enlarged prostate is also known as benign prostatic hyperplasia (BPH). BPH is generally not caused by infection or cancer.
As a man matures, the prostate grows. At puberty, the prostate doubles in size. At about age 25, the prostate gland grows again, and this can lead to an enlarged prostate as a man enters his 40s (Source: NIDDK).
An enlarged prostate many not cause any symptoms or noticeable problems in some men. However, as men age, an enlarged prostate may grow to the point where it presses on the bladder and urethra, causing urine flow to be slower and less forceful. Symptoms of enlarged prostate are very common in men in the 60s and extremely common in men in their 70s and 80s.
If an enlarged prostate prevents complete emptying of your bladder, it may lead to a urinary tract infection or permanent damage to your bladder, including the inability to control urination (incontinence). The earlier the enlarged prostate is found, the more effective treatment will be, lowering the risk for complications.
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
Anatomy of prostate
physiology of prostate
definition of B.P.H
Etiology of Benign Prostatic Hyperplasia
symptoms of Benign Prostatic Hyperplasia
pathology of Benign Prostatic Hyperplasia
pathophysiology of Benign Prostatic Hyperplasia
Diagnosis of Benign Prostatic Hyperplasia
Symptoms of Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.
Decreased caliber and force of the stream
Problems starting(hesitancy) and stopping urine stream; post-void dribbling
Impaired bladder emptying
- high risk of infection and hydronephrosis
Urinary retention
Incontinence
Nocturia; polyuria / Dysuria
Hypertrophy of bladder wall muscle
- increased risk for bladder diverticula
Microscopic hematuria maybe present
An enlarged prostate is the slow growth of the prostate gland, which is involved in the production of seminal fluid and reproductive function in men. The prostate wraps around the tube that transports urine out of the bladder. It is very common for the prostate gland to become enlarged as a man ages. An enlarged prostate is also known as benign prostatic hyperplasia (BPH). BPH is generally not caused by infection or cancer.
As a man matures, the prostate grows. At puberty, the prostate doubles in size. At about age 25, the prostate gland grows again, and this can lead to an enlarged prostate as a man enters his 40s (Source: NIDDK).
An enlarged prostate many not cause any symptoms or noticeable problems in some men. However, as men age, an enlarged prostate may grow to the point where it presses on the bladder and urethra, causing urine flow to be slower and less forceful. Symptoms of enlarged prostate are very common in men in the 60s and extremely common in men in their 70s and 80s.
If an enlarged prostate prevents complete emptying of your bladder, it may lead to a urinary tract infection or permanent damage to your bladder, including the inability to control urination (incontinence). The earlier the enlarged prostate is found, the more effective treatment will be, lowering the risk for complications.
A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and BPH.
Anatomy of prostate
physiology of prostate
definition of B.P.H
Etiology of Benign Prostatic Hyperplasia
symptoms of Benign Prostatic Hyperplasia
pathology of Benign Prostatic Hyperplasia
pathophysiology of Benign Prostatic Hyperplasia
Diagnosis of Benign Prostatic Hyperplasia
Symptoms of Benign Prostatic Hyperplasia
Surgical management of pancreatic pseudocyst..by dr chris alumonaCHRIS ALUMONA
Pancreatic pseudocyst is the commonest cystic lesion of the pancreas but generally rare. It commonly complicates pancreatitis and resolves spontaneously with conservative management. Indications for intervention include complications and to rule out malignancy
here give the knowledge that you should possess to manage acute and chronic urine retention. the lecture is more concerned about practical patient care and ward setting management. you should minimally be aware about following facts regarding urine retention. the multiple causes of retention will be discussed later in detailed manner. Direction of the lecture seems more toward BPH and acute retention management. beware there are many aspects of a patient present with an AUR. do no harm and always try to keep patient satisfaction. Let me know about your comments an Ideas. try to improve the quality. good luck.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Laparosopic management
of recurrent hematospermia
Dr Santosh Agrawal
MCh ( Urology), FIAGES, FALS
Fellow Robotic Surgery
( Roswell Park Cancer institute Buffalo, NY, USA)
2. • Blood in the semen
• Usually self limiting
• Recurrent and persistent hematospermia –
needs evaluation
3. Index case
• 47/Male
• C/C - blood in the semen since 2 months, present in each
ejaculate, not associated with pain or urinary symptoms
- No urinary complaints
• Past H/O - No h/o hypertension, tuberculosis, antiplatlet or
anticoagulant
• No h/o any scrotal, inguinal or prostate surgery
• Pers. H/O - Non alcoholic & smoker
• O/E - Conscious & oriented
– Vitals - Tº - Afebrile , P- 78/min , B.P.- 130/80 mmhg
– P/A - Soft , Non-tender, bilateral testes, vas , epid normal
– P/R - No abnormality detected
• No prostatic or supra prostati mass felt, prostate benign feel non tender
• Seminal vesicle not felt/non tender
4. Investigations
Hb – 15.5 TLC- 7100 Platlet- 2.2 M/Cc
Urine R/M = RBC- nil ,
1 – 2 pus cells.
Urine C/S = No
growth
Semen Analysis = full
of RBC’s present
S.PSA = 1.24 ng /ml
Urine AFB – All the 3
samples negative
USG- Scrotum
• B/L testes normal
• B/L epididymis – no
abnormality
• B/L - no Varicocele
5. TRUS
• B/L – SV- normal size, shape & echotexture.
• Prostate - normal in size & shape = 12.7 ml
• Periurethral area appears normal.
• Central zone of prostate shows normal echotexture .
• Peripheral zone appears normal with slightly hyperechoic texture .
• Few tiny calcific foci in bilateral ejaculatory duct course with in the
central zone .
6. Management
Conservative management for 2 months on OPD basis – antibiotic and
anti inflammatory
•Show bood coming out from left ejaculatory duct
Cystoscopy and seminal vesiculoscopy attempted
Again one month of conservative management advised
No relief in hematospermia
Psychological stress , anxiety /depressive symptoms
Cystocopy/seminal vesiculoscopy /seminal vesiculetomy advised
7. MRI- Pelvis
MRI pelvis study including prostate reveals no significant abnormality
, except for hemorrhage in left SV
Right Left
8. Surgery
• Cystoscopy and seminal vesiculoscopy
Laparoscopic Excision of left Seminal Vesicle
C
5
10
Bladder
9.
10. Post-Operative
• Operative time = 130 min
• Blood loss = 50 ml
• No intraoperative complications
• Drain removal – POD 3
• Foleys Removal – POD 2
• Discharge – POD 4
11. HPE
• Two soft tissue pieces & vas deferens
– SV- showing few cystically dilated ducts with calcified secretion, luminal
papillae showing proliferation of blood vessels with congestion.
– No evidence of inflammatory change
• Section from vas show inflammatory cells & RBC in lumen
• Impression : Obstructive pathology – Seminal vesicle
12. Follow up
• Devoloped fever dysuria and perineal pain
after 15 days
• USG – showed collection in retro vesicle space
• Transrectal aspiration was done.
• Patient immediately improved
• Post op 8 month- no hematospermia, sexual
funtion ok.
13. Discussion
• < 40 years – almost always benign
• >40 years – usually benign, rarely associated
with malignency
17. Work up
• History
• Physical examination
• Investigation
– CBC, coagulation profile
– Urine routine and culture
– Semen analysis and culture
– Serum PSA
– TRUS
– MRI
18. Seminal Vessel Endoscopy
• 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%.
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
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 hematospermia or associated symptoms such as hematuria, excluding urogenital malignancy is essential.[3]Next Section: Physical
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.
Consider the following in the genital examination:The penis should be carefully inspected to rule out any lesions that may bleed and contribute to the ejaculate. The vasa should be palpated along their entire course to ensure their presence and to rule out any induration or nodularity. Any nodularity in the absence of prior vasal surgery (including vasectomy) should raise concern for a tuberculous infection of the vasa. Alternatively, nodules within the vas rarely represent extension of prostatic or bladder malignancies. Upon digital rectal examination (DRE), special attention should be given to the seminal vesicles and the presence of any midline masses. The seminal vesicles are routinely nonpalpable structures. If they are palpable, this generally indicates significant underlying pathology. In older men (>50 y), specific attention should also be given to the prostate because hematospermia is occasionally a harbinger of prostate cancer.
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.[9]
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.
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.
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.[1
Persistent hematospermia (>3 mo) without an antecedent cause or persistent hematospermia associated with an abnormality on ultrasonography or MRI may prompt further evaluation.