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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3682
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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I am an FNP in a family practice and I have just a few

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Hi, I am an FNP in a family practice and I have just a few questions. I've had several patients come in with hemataspermia, middle aged men age 50-60, no past medical hx besides maybe a little HTN. They both had occasional bright red, to dark red ejaculations post coital with their spouse and with self stimulation to confirm the issue. Both patients also had not't had well exams for a number of years. Both patients also had pressure/discomfort in the scrotum that would be uncomfortably/painful. So my question is, when should I refer on to urology and what work-up do Urologists typically like to be done before the patient gets there? ie. lab work, imaging etc. And is Hemataspermia typically worrisome in the older adult male? Thanks! Sean

HI Sean,

Hematospermia is one of the most harmless conditions in urology, but it gets the patient really scared.

But in reality it is a totally harmless condition and almost always settles of its own in some time.So the first step is reassurance to the patient and make him understand this is nothing to worried about.The condition will settle gradually.
The most common cause appears to be minor inflammation of the prostate gland or seminal vesicles.It is also commonly seen in males who engage in sexual activity after a long gap.

Only if it persists beyond several weeks or months, further tests need to be done.Most often Urine cytology, trans-rectal ultrasound,PSA and MRI scan is done to find out any rare causes of this blood in semen.

Before referring to urology you can try a short course of antibiotic and anti-inflammatory drugs.If it still persists, then urologist can be helpful.

I hope this answers your question.


Customer: replied 4 years ago.

That is very reassuring! Thank you. What about microscopic hematuria in a similar age group? This seems to show up with some frequency and I cannot usually find a cause. They are not athletes, and no other reason I can find. They just have + microhematuria per UA and under the microscope. No other symptoms. I just don't want to miss something like bladder cancer. Does bladder cancer present with any other typical symptoms and what tests should I do or what type of things should I rule out before referring on for this (besides the obvious things like infection)? I have in the past erred on the side of letting the urologist order the Urogram as I don't want to unnecessarily expose the patient to radiation, but I also don't want to waste your time in the specialists office for every little microhematuria that comes in but yet persists


Microscopic hematuria needs to fully investigated in high risk individuals - advanced age(>65), smokers, family history of urological malignancy and hypertensive patients.
In these sub group, there is no harm in going for an urogram directly along with other tests(urine cytology, PSA ).Cystoscopy is optional.

Rest all can be ordered an urine cytology and Ultrasound scan.But they have to followed up every 6 months to 1 year if there is no particular cause found.

Bladder cancer most often presents with blood in urine and sometimes lower urinary tract symptoms like frequency, urgency etc.


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