Hematospermia: an unusual cause of urology emergency Muhammad Hilmi H et al. https://doi.org/10.17576/JSA.2017.0701.16 Journal of Surgical Academia 2017; 7(1): 72-74 72 Hematospermia: An Unusual Cause of Urology Emergency Muhammad Hilmi H 1 , Goh EH 1 , Tan GH 1 , Rozman Z 2 , Nik Azuan NI 2 , Fam XI 1 , Mohd Hafidzul J 1 () 1 Urology Unit, Department of Surgery, 2 Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Abstract Hematospermia is a distressing disorder in sexually active men resulting in great concern to the patient. We report an unusual case of hematospermia with an atypical presentation, involving a 54-year-old man presented with acute urinary retention after sexual intercourse. Although the causes are widely known, arteriovenous malformation as the cause of this disorder has not much been reported in the literature. Transcatheter embolization of internal pudendal artery is a promising option for hematospermia caused by arterial fistula or bleeding. Keywords: Arteriovenous fistula, digital subtraction angiography, embolization, hematospermia Correspondence: Muhammad Hilmi Hashim. Urology Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91456201 Fax: +603- 91456684 Email: hilmihashim.mhh@gmail.com Date of submission: 17 March, 2017 Date of acceptance: 6 Apr, 2017 Introduction Hematospermia is defined by the appearance of the blood in the ejaculate (1). Although, the true incidence or prevalence of this condition is unknown, it is suggested to be 0.5% from population attending for prostate cancer screening (2). Despite the fact this disorder usually is not linked to serious condition, it may indicate significant underlying genitourinary pathology including prostate malignancy. Hence, thorough assessment and treatment is clearly needed. Case Report A 54-year-old man presented with acute urinary retention to the emergency department requiring catheterisation and bed-side clot evacuation. Fortunately, the bleeding was self-limiting and no further intervention was needed after that. He was otherwise well and had no urinary symptoms. The patient claimed not to be a smoker and his occupation was largely office-based. Medically, he also was a case of ischemic heart disease and hypertension on two antiplatelet medications, aspirin and clopidogrel. Only on further questioning, the patient revealed having sexual intercourse about ten hours prior to the presentation. In fact, he admitted to be having hematospermia with minimal hematuria for the last two years. The patient disclosed the hematospermia episodes only occurred a few months after he met an accident whereby he sustained cerebral concussion, multiple cervical injuries and fractured of the right fourth metatarsal bone. However, he was not able to remember whether there was any injury to the pelvic region. Physical examination of the patient including the genitalia and prostate was unremarkable, so was the blood test, with PSA 0.49ng/ml. The International Index of Erectile Function (IIEF-5) was 23. Both cystoscopic examination and ultrasound did not detect any abnormality. The history of motor vehicular accident close to onset of hematospermia raised the suspicion of vascular abnormality hence computed tomography angiography was performed, revealing abnormal enhancement at the base of penis, potentially Case Report