Accueil Recherche NouveautésEmail webmaster Tous les textes - FMCSommaire généralPage précédente
HEMOSPERMIE ou HEMATOSPERMIE
Présence de sang dans le sperme
Apartir de Uropage.com
MAJ 2009

Une cause fréquente de sang dans le sperme est la présence d'une inflammation ou d'une infection dans la prostate et/ou les vésicules semainles mais une urétrite doit également être rechercheé.

En général, on fait dans ce cas un examen des urines et du sperme (spermoculture), et on traite pendant quelques semaines par un antibiotique (voir "Prostatite").

L'absence d'infection fait parfois évoquer une fragilité des capillaires, télangiectasies et varices d'où parfois l'essai de traitements par veinotoniques.

Les suites immédiates d'une biopsie de la prostate entrainent souvent une hémopsermie 9 - 45%) généralement spontanément résolutive en quelques semaines.

Toutefois, certains auteurs estiment que l'hemospermie peut révéler un cancer de la prostate. Dans le suivie de 150 patients ayant consulté pour hémospermie isolée et idiopathique, 6 d'entre eux ont ensuite developpé un carcinome de la prostate (http://www.emedicine.com/med/topic3466.htm).
Esculape : Il est difficile d'affirmer sur ces simples faits une relation entre les deux pathologies

La présence de sang dans le sperme n'a aucune influence sur les capacités sexuelles. Le sang dans le sperme n'est pas un symptôme évocateur de cancer mais peut être le seul signe d'appel.

Imagerie (Dr Mascarel - radiologue)
Si bilan infectieux négatif rechercher une lésion qui saigne
L’écho des bourses va rechercher une tumeur testiculaire ou de l’épidydime.
L’écho prostatique va rechercher
--- une lésion maligne des vésicules séminales et de la prostate
--- une pathologie bénigne comme un kyste prostatique , un kyste de l’épididyme , une lithiase prostatique ...
Si écho prostatique anormale et/ou PSA augmentés, l’IRM permettra de faire un bilan lésionnel qu’il s’agisse d’une lésion tumorale ou bénigne.
Si tout le bilan est négatif et que l’hémospermie persiste éliminer lésion de l’urétre par urétro-cystographie
[Texte complet et images]

=============================================

Par ailleurs
(http://www.emedicine.com/med/topic3466.htm).
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 complaint. 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.

Infections
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.

Parasites
Several authors report 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
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.

Systemic disorders
Systemic disorders that are associated with hematospermia include hypertension, chronic liver disease, amyloidosis, lymphoma, and bleeding diatheses (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 severe uncontrolled hypertension, elevated serum creatinine levels, severe proteinuria, and renovascular disease.
MAJ 2009
Clinical Recommendations (http://www.medscape.com/viewarticle/714316?src=mp&spon=34&uac=121613SZ)

The first step of the history is to rule out pseudo-hematospermia by determining if hematuria is being misinterpreted as hematospermia or if the blood may have been from the patient's sexual partner (e.g., ask about his partner's possible menstruation or genitourinary infection, and about intense sexual behavior),"

Once true hematospermia has been confirmed, specific key clinical recommendations for practice, all rated level of evidence, C, are as follows:
  • Men younger than 40 years who have limited episodes of hematospermia and no risk factors or associated symptoms can be assessed for common genitourinary tract diseases, given appropriate therapy as indicated, and reassured.
  • For those men with hematospermia who are 40 years or older, who have associated symptoms, or who have persistent hematospermia, assessment should be more comprehensive and should include evaluation for underlying prostate cancer.
  • For low-volume hematospermia of iatrogenic cause, observation is typically the most appropriate management strategy because these cases of hematospermia are often self-limiting.
Accueil NouveautésEmail webmaster Sommaire FMC Sommaire généralPage précédente