Etiology of Hematospermia in Turkish Men: Multicentric Study.

Background: Hematospermia is defined as the presence of blood in the semen. The data regarding its etiology and management is variable across the literature.

Aims: To investigate the etiology of hematospermia in Türkiye so as to contribute to the current management strategies for hematospermia.

Methods: An online study protocol was published through the Turkish Urology Association communication network, and the centers that met the criteria were included in the study. All patients who presented with hematospermia complaints in the past 1 year were subjected to detailed anamnesis, physical examination, and routine laboratory tests. Based on the results, the patients were assigned to Group 1 (patients aged < 40 years with only one episode of hematospermia in the past 6 months) or Group 2 (patients with concomitant symptoms or ≥ 40 years or ≥ 2 times in the past 6 months). Radiological imaging was performed for the patients in Group 2.

Results: A total of 199 patients (Group 1: 44, Group 2: 155; mean age: 43.07 ± 14.73 years; age range: 16-73 years) from across 42 cities and 22 different centers were enrolled in this study. In the etiological classification, inflammation was identified as the most common cause (n = 76, 38.1%). Idiopathic hematospermia was higher in Group 1 than in Group 2 (70.4% vs. 112.2%, respectively), and hematospermia was associated with malignancy in 9 (5.8%) Group 2 patients. Positivity was detected in urine or semen cultures in 20 (12.9%) patients, and hematospermia occurred after COVID-19 infection in 2 patients. A significant correlation was noted between patients showing no-concomitant symptoms and those showing idiopathic hematospermia, inflammation, malignancy, varicocele, and multiple etiological factors (p = 0.004, p = 0.028, p = 0.002, p = 0.001, p = 0.026, p = 0.016). The most common radiological findings were an increase in the prostate volume (n = 48, 30.9%) and changes in the signal intensities of the seminal vesicles (n = 29, 18.7%). Despite the use of different approaches to manage idiopathic hematospermia, the patients' survey results were generally similar.

Conclusion: Hematospermia in all age groups occurs generally due to self-limiting benign causes. Diagnostic imaging should therefore evaluate the elucidate etiology in patients with identified risk factors so as to avoid unnecessary treatments in idiopathic patients.