The goal of this study was to explore minimally invasive transurethral imaging and surgery for the treatment of severe, persistent
hematospermia in cases that were refractory to
conservative treatments. The study included 43 patients (aged 22-77 years; average, 44.6 years) with long-lasting, severe
hematospermia, accompanied by discomfort or
pain in the lumbosacral or perineal region,
dysuria, frequent micturition, decreased semen volume, and/or
azoospermia. Patient symptoms had persisted for 1 to 10 years (average, 5.3 years). Computed tomography or magnetic resonance imaging of each patient was evaluated, and transurethral surgery was performed. The causes of
hematospermia were identified in all 43 patients, and their ejaculatory duct obstruction or seminal vesiculitis was successfully treated. No serious intraoperative or postoperative complications occurred. Pathologic analyses revealed that all of the resected or biopsied seminal vesicle tissues had chronic nonspecific
inflammation in the seminal vesicle wall, and no
tumors were identified. Preoperative symptomology of
hematospermia disappeared in all patients followed up for 2 to 30 months (average, 16 months). A single patient experienced recurrence at 11 months and had a second
minimally invasive surgery that was curative. A total of 95.3% (41 of 43) of the patients experienced normal orgasmic intensity after surgery. Magnetic resonance imaging is a valuable and accurate diagnostic method for the identification of causative factors underlying
hematospermia. Transurethral dilation of ejaculatory ducts, incision of the verumontanum or the distal end of the ejaculatory ducts, and incision or resection of the relevant
cysts represent simple, safe, and reliable approaches for the management of refractory cases of
hematospermia that do not respond to
conservative treatments.