The sanguineous sperm ( hemospermia ) — current appraisal and review

Aims: Hemospermia is an infrequently discussed urological problem. Most health care providers including general surgeons and physicians are unfamiliar with this disorder, its etiology & management. We undertook the present review to ascertain the magnitude of this problem and to device a working algorithm to help the clinician in approaching a case of hematospermia. The symptoms, differential diagnosis and management have been discussed. Materials and Methods: An Internet search was made over the ‘Pubmed’ for indexed publications in the English literature using the keywords hematospermia; hemospermia and bloody urethral discharge. Results: The search yielded about 75 indexed publications. These were reviewed and analyzed to determine the various etiological factors, differential diagnosis and their management. We have suggested a clinical working algorithm and a protocol to deal with cases of hemospermia. Conclusions: Hemospermia is not an uncommon urological disorder. The problem is often idiopathic, transient and self-limiting in more than half the cases. Polysymptomatic persistent hemospermia especially in the elderly may herald a more serious underlying problem that should be investigated thoroughly to rule out malignancy. While not all cases merit an extensive workup, selected cases of recurrent, symptomatic hemospermia associated with other abnormalities may be analyzed in greater detail. The stepwise clinical working algorithm suggested and devised by us on the basis of published cases will assist the treating surgeon/urologist in the evaluation of such suspected cases of hemospermia.