Abnormalities may include calcifications or calculi in the prostate, ejaculatory ducts, or seminal Hematospermia vesicles; seminal vesicle, ejaculatory duct, or prostatic cysts; benign prostatic hypertrophy; prostatitis; and Cowper gland masses. However, it is important to consider that some of these abnormalities can be found in asymptomatic patients, such as benign prostatic hyperplasia and prostatic calcifications, which are age-related changes, and nonobstructing prostatic cysts [10,13,28,29]. TRUS has shown utility in guiding transperineal aspiration of the seminal vesicles [4]. A recent prospective trial enrolled 106 patients with persistent HS and found the diagnostic accuracy of TRUS and transurethral seminal vesiculoscopy was 45.3% and 74.5%, respectively, although the diagnostic accuracy was higher when both modalities were combined. Vesiculoscopy was most useful in the detection of calculi and obstruction/stricture at the level of the verumontanum orifice or ejaculatory duct [19]. Computed tomography CT has very limited value in the etiologic determination of HS for the reasons described above. Pelvic angiography Angiography has been reported sparsely in the literature to be useful for vascular masses when evaluating men with intractable HS with or without hematuria when clinical, laboratory, and noninvasive imaging evaluations have not revealed the etiology. If an arterial source of hemorrhage is identified, transcatheter arterial embolization can be performed during the same session as well [23]. Although there are references that report on studies with design limitations, 3 good-quality studies provide good evidence. Relative Radiation Level Information Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with
Hematospermia. Abnormalities may include calcifications or calculi in the prostate, ejaculatory ducts, or seminal Hematospermia vesicles; seminal vesicle, ejaculatory duct, or prostatic cysts; benign prostatic hypertrophy; prostatitis; and Cowper gland masses. However, it is important to consider that some of these abnormalities can be found in asymptomatic patients, such as benign prostatic hyperplasia and prostatic calcifications, which are age-related changes, and nonobstructing prostatic cysts [10,13,28,29]. TRUS has shown utility in guiding transperineal aspiration of the seminal vesicles [4]. A recent prospective trial enrolled 106 patients with persistent HS and found the diagnostic accuracy of TRUS and transurethral seminal vesiculoscopy was 45.3% and 74.5%, respectively, although the diagnostic accuracy was higher when both modalities were combined. Vesiculoscopy was most useful in the detection of calculi and obstruction/stricture at the level of the verumontanum orifice or ejaculatory duct [19]. Computed tomography CT has very limited value in the etiologic determination of HS for the reasons described above. Pelvic angiography Angiography has been reported sparsely in the literature to be useful for vascular masses when evaluating men with intractable HS with or without hematuria when clinical, laboratory, and noninvasive imaging evaluations have not revealed the etiology. If an arterial source of hemorrhage is identified, transcatheter arterial embolization can be performed during the same session as well [23]. Although there are references that report on studies with design limitations, 3 good-quality studies provide good evidence. Relative Radiation Level Information Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with