The increasing availability of 3T MRI, which offers a higher signal-to-noise ratio and improved spatial resolution, may preclude the use of an endorectal coil for evaluating the seminal tract [22]. Computed tomography Computed tomography (CT) is a noninvasive imaging modality that uses ionizing radiation to identify calcifications, gross soft-tissue masses, or cystic lesions of the prostate gland and seminal vesicles. However, it has limited value in the etiologic determination of HS given its lack of soft-tissue contrast and limitation in differentiating structural changes of the prostate and seminal tract [11,21]. Pelvic angiography Pelvic angiography can be useful to evaluate for vascular causes of HS and is mainly reserved for men with intractable HS with or without hematuria when clinical, laboratory, and noninvasive imaging evaluations have not revealed an etiology. If an arterial source of hemorrhage is identified, such as from the internal pudendal artery, transcatheter arterial embolization can be performed in the same session for therapeutic purposes [23]. Discussion of Imaging Modalities by Variant Factors that determine the extent of investigation are patient age, duration of HS, and associated symptoms and signs. However, a confounding issue is that currently there are no consensus or society guidelines on the distinction between transient or episodic HS and persistent HS. The distinction has been based on either the number of ejaculates or a specific time period, with differing opinions. Ultimately the decision to pursue further investigation will be made by the referring physician, typically a urologist. TRUS Many investigators have reported that TRUS should be used as the first-line imaging tool in this patient population. TRUS is very sensitive for detecting a variety of abnormalities that may involve the prostate gland and seminal tract in the setting of HS, reportedly demonstrating abnormalities in 82% to 95% of men with HS [4,12,13,19,21].
Hematospermia. The increasing availability of 3T MRI, which offers a higher signal-to-noise ratio and improved spatial resolution, may preclude the use of an endorectal coil for evaluating the seminal tract [22]. Computed tomography Computed tomography (CT) is a noninvasive imaging modality that uses ionizing radiation to identify calcifications, gross soft-tissue masses, or cystic lesions of the prostate gland and seminal vesicles. However, it has limited value in the etiologic determination of HS given its lack of soft-tissue contrast and limitation in differentiating structural changes of the prostate and seminal tract [11,21]. Pelvic angiography Pelvic angiography can be useful to evaluate for vascular causes of HS and is mainly reserved for men with intractable HS with or without hematuria when clinical, laboratory, and noninvasive imaging evaluations have not revealed an etiology. If an arterial source of hemorrhage is identified, such as from the internal pudendal artery, transcatheter arterial embolization can be performed in the same session for therapeutic purposes [23]. Discussion of Imaging Modalities by Variant Factors that determine the extent of investigation are patient age, duration of HS, and associated symptoms and signs. However, a confounding issue is that currently there are no consensus or society guidelines on the distinction between transient or episodic HS and persistent HS. The distinction has been based on either the number of ejaculates or a specific time period, with differing opinions. Ultimately the decision to pursue further investigation will be made by the referring physician, typically a urologist. TRUS Many investigators have reported that TRUS should be used as the first-line imaging tool in this patient population. TRUS is very sensitive for detecting a variety of abnormalities that may involve the prostate gland and seminal tract in the setting of HS, reportedly demonstrating abnormalities in 82% to 95% of men with HS [4,12,13,19,21].