I. Concept Hemosperm is a disease in which blood is mixed in the semen. Depending on the amount of blood contained, it may appear as naked-eye hematosperm, clots containing blood, or only a small amount of red blood cells under the microscope. Hemospermia is one of the disorders of the male reproductive system, with an incidence of about 1%. Most of them are caused by benign lesions and are more common in patients under 40 years of age. At least 70% of hematospermia in patients under 30 years of age is caused by inflammation, while 5%-10% of hematospermia patients over 40 years of age have malignant changes if the hematospermia persists for more than a few months. Second, the etiology Where does the blood come from? It is nothing but a lesion in one of the tissue parts of the sperm running pathway. The components of semen, apart from the sperm with very little volume, mainly come from the seminal vesicle gland, followed by the prostate gland. Patients with hematospermia can be divided into 3 categories according to different etiologies: pathological hematospermia, functional hematospermia and idiopathic hematospermia. (a) Pathological hematospermia mainly has the following causes: 1. Inflammation: (with or without urinary frequency, urinary urgency, urinary pain and other urinary tract infection symptoms) seminal vesiculitis and prostatitis, urethritis. Spermatorrhea: chronic spermatorrhea can easily lead to hypertrophy of the sperm testis, causing difficulty in urination and painful ejaculation. As the seminiferous tissue is congested and edematous, the mucosa is prone to rupture and bleeding. Especially during sexual intercourse, the posterior urethra is strongly contracted and more likely to appear hemorrhagic. The wall of the seminal vesicle gland is very thin, and once it is congested, the vesicle wall, which is covered with blood vessels, can easily bleed. Therefore, the most common cause of hematospermia is first of all seminal vesicle adenitis, which can easily turn chronic due to poor drainage, thus causing secondary vas deferens obstruction and edematous obstruction of the ejaculatory orifice, resulting in dry ejaculation with only ejaculatory action but no semen discharge. This is the mechanism by which hematosperm causes infertility. The second is prostatitis and posterior urethritis or posterior urethral congestion and other conditions. When the urethra is inflamed, especially the urethral inflammation at the seminal vesicle, hematospermia is likely to occur, which is characterized by blood in the anterior segment of the semen. It can also cause inflammation, swelling, congestion and bleeding in the wall of the seminal vesicle gland due to the spread of inflammation in other adjacent organs. 2, tumor (with or without urinary tract obstruction symptoms such as difficulty in urination) (1) benign tumors such as seminal gland cyst, hemangioma, seminal vesicle smooth muscle tumor, seminiferous papilloma, prostatic hypertrophy, etc.; (2) malignant tumors such as seminal vesicle adenocarcinoma, prostate cancer, tumors of the urethral part of the bladder and testicular tumors, etc.; (3) hematospermia caused by inflammation will be better and worse, and will heal from time to time, while hematospermia caused by tumors will have increasingly severe symptoms. 3, congenital: such as ectopic ureter, the opening of the ureter is easy to cause hematospermia when the ureter is in the urethra; 4, tuberculosis (with or without coughing up sputum, coughing up blood, low fever in the afternoon, night sweats and other symptoms of tuberculosis, if white blood cells are found in the semen and it still does not heal after repeated antibacterial treatment, the possibility of tuberculosis should be considered at this time). 5, other varicocele, repeated compression of the perineum, urethra, testicles or perineal injury, etc. Varicose veins in the posterior urethra: there are many small veins in the neck of the bladder that continue directly to the posterior urethra, these small veins migrate and expand, and the strong contraction of the posterior urethra during sexual intercourse to discharge sperm makes the small veins rupture, causing hematospermia. The frequent sexual intercourse makes the prostate gland and seminal vesicles overly congested, which can also cause hematospermia. Especially when the urethral mucosa is damaged, the semen can be bloody. The hemorrhage department is related to the degree of injury, with minor injury to the anterior segment of semen with blood, or microscopic hematuria. Severe injury, not only the semen is bright red, and the phenomenon of blood dripping from the urethra. 6, systemic causes (with or without easy bleeding tendency) such as purpura, liver cirrhosis, schistosomiasis, leukemia, etc. (hemorrhoid plexus and prostatic venous plexus in the case of liver cirrhosis the role of collateral circulation can produce hematospermia; it has also been reported that hematospermia is caused by schistosomiasis and live schistosome larvae were found in the semen;) (1) testicular lesions: testicular tumors (2) seminal vesicle lesions: such as seminal vesiculitis, seminal vesicle tuberculosis, seminal vesicle (3) prostate lesions: such as prostatitis, prostate hyperplasia, prostate cancer (4) urethral lesions: urethritis, tumors in the urethra of the bladder, papilloma of the seminal vesicle, ectopic uretero-urethral opening, (2) functional hematospermia The most common cause of hematospermia is vesiculitis, but medically there are also hematospermia caused by non-disease factors, called as functional hematospermia coenergetic hematospermia, mostly due to excessive sexual It is mostly related to excessive sexual indulgence. The most common cause is vesiculitis. It turns out that the wall of the seminal vesicles is naturally very thin, and there are many capillaries with thin and brittle walls, so once the seminal vesicles are affected by factors such as contraction or pressure, these capillary walls are prone to rupture and bleeding, resulting in hematospermia. The mechanism is: the moment of sexual ejaculation, the seminal vesicles will contract strongly, from the original relaxed state to the contracted state, and the pressure in the seminal vesicles will suddenly increase. When ejaculation is over, the fluid in the seminal vesicles is emptied rapidly, and the pressure suddenly drops, so it immediately returns to the relaxed state from the contracted state. This big change in pressure can easily cause changes in the permeability of these capillaries, resulting in blood leakage from the capillary walls. The diagnosis of functional hematospermia is largely based on the medical history, but some necessary tests should also be performed. The specific diagnostic points are as follows: 1. No sexual life for a long time, once sexual life that appears hematosperm. After sexual life resumes with a certain frequency, the hematosperm disappears. However, when the number of sexual intercourse is significantly reduced again, or even after stopping for a period of time, hematospermia will occur repeatedly. 2. Except for the presence of red blood cells in the semen, there are no abnormalities such as white blood cells or pathogens in the semen. 3. Various examinations related to hematospermia, including B-ultrasound or X-ray examination of seminal vesicles, prostate, bladder and urethra, did not reveal any disease. In addition, systemic blood system examination, there is no systemic bleeding disorder. 4. Each episode of hematemesis lasts for no more than 5-7 d. 5. Despite the occurrence of hematemesis, the patient’s general condition remains good, and there are no uncomfortable clinical symptoms. (C) Idiopathic hematosperm The cause of idiopathic hematosperm is due to bleeding caused by a sudden drop in pressure in the glandular cavity after the sudden emptying of the swollen seminal vesicle gland, which is related to long-term abstinence. Diagnosis: (a) physical examination 1. body temperature, blood pressure, tongue coating, bleeding spots or purple spots on the skin, pulmonary rales, pressure pain in the liver area, urethral discharge, perineal pressure pain, 2. anal examination: touch the prostate gland, size of the seminal vesicles, the presence of pain, and importantly, the presence of tumors. 3, testicular epididymis and spermatic cord, rectal finger examination to exclude prostate or seminal cysts or masses, observation of bleeding from the urethra after finger examination (2), laboratory tests 1, primary screening items: penile condom test, semen routine: in addition to confirming the presence of hematospermia, can also know the number of sperm, mobility, morphology, the presence of inflammation; 2, further examination items: (1) urinalysis: to detect whether there is urinary system inflammation; (2) urine analysis: to detect the presence of urinary system inflammation; (3) urine analysis: to detect the presence of urinary system inflammation. (2) Hematological examination: routine blood, platelets, clotting time, PSA; (3) semen bacterial culture and drug sensitivity and cytology; (4) prostate fluid routine, bacterial culture and drug sensitivity and cytology; (5) X-ray: seminal vesiculography; intravenous pyelography for ectopic ureter; X-ray can detect seminal vesicle calcification; seminal vesiculography has important diagnostic value for seminal vesicle inflammation, cysts, diverticula and tumors. (6) transrectal ultrasound: transrectal ultrasound is considered a preferred method to screen the prostate and seminal vesicles for stones, tumors, hypertrophy and other abnormal changes. (7) CT examination, MRI examination CT and MRI are of great value for the staging of prostate cancer. (8) Cystoscopy and urethroscopy: to see the size of the prostate, whether there is vascular congestion, and whether the urethra is normal or not. 83% of patients with TURS show abnormalities, and in case of abnormalities, a puncture biopsy should be done at the same time. The explanation is sufficient. If pathological factors are ruled out, treatment should generally be directed at the cause. 1. The focus of treatment should first be on adjusting the frequency of sexual life, avoiding rough intercourse, and preventing irregular sexual intercourse. During an episode of hematospermia, one should stop having sex for a period of time and avoid sexual excitement to avoid aggravating the congestion of the genital organs. After the hematosperm disappears, at most 2~3 weeks, you should gradually resume sexual life, and develop the habit of regular sexual life, for example, 4~5d once, at most not more than a week, so that the seminal vesicles and other reproductive organs start to enter a regular seminal discharge “program”. 2, avoid drinking alcohol and spicy stimulating food, so as not to aggravate the degree of congestion; do not ride a long distance, horseback riding; 3, once a week the vesicle gland prostate massage to help discharge inflammatory secretions; 4, hot water bath once a day, 15-20 minutes each time, water temperature 41-42 ° C; 5, if the infection is caused by the appropriate sensitive antibiotics and the prostate vesicle massage to help into the inflammatory secretions; 6, the use of hemostatic drugs to help stop bleeding. The use of hemostatic drugs to help stop bleeding. The most common drugs used to stop bleeding are anaerobic, hemostatic cyclic acid, aminobenzoic acid, vitamin K, hemostat, lithopodium, etc., and can also be used to stop bleeding with Chinese herbs, such as artichoke, artichoke, cypress charcoal, etc. Take vitamin C. This drug has the function of enhancing the function of capillary walls and is helpful in relieving bleeding or oozing from broken capillaries. Even after the hematemesis has stopped, taking vitamin C regularly is good for preventing the recurrence of hematemesis. 7, do not drink alcohol, also eat less or do not eat spicy, spicy and other stimulating food, such as onions, peppers, onions, garlic, pepper, etc., in order to avoid increasing the degree of capillary congestion in the reproductive organs. Avoiding cold and moisture can also reduce the degree of capillary congestion in the genital organs. It is worth mentioning that according to the literature, there are individual patients with functional hematospermia, not because of the above-mentioned factors of strong contraction of the seminal vesicles or sudden pressure changes, but because of the influence of certain enzymes in the human body, or some men are born with allergies, and although the seminal vesicles are not diseased, they are affected by systemic allergies, and some enzymes within the seminal fluid that can dissolve tissue fibers increase in activity, which can easily make the mucous membrane of the inner wall of the seminal vesicles The capillary wall on the surface of the seminal vesicles is damaged and the coagulability of the exuded blood is also reduced, causing hematospermia. Therefore, for patients with functional hematospermia who are clearly allergic, or for those who have been untreated for a long time, while continuing the above prevention and treatment measures, they can take appropriate anti-allergy drugs, such as Benadryl and Xylazine, which may also help to overcome such hematospermia. 8.Physical therapy and Chinese medicine treatment can also be used. 9.If cystic lesion is feasible, ultrasound-guided cyst puncture or transurethral cyst debulking is possible. 10.Urethral polyps, posterior urethral varicose veins, papillary urethritis should be removed or electrocautery after biopsy to exclude malignant changes. 11.Seminal vesicle cancer should be treated radically. 12.Seminal vesicle microscopy is feasible for persistent hematospermia.