OBJECTIVETo evaluate the long-term efficacy of transrectal ultrasonography (TRUS)-guided transperineal needle aspiration and irrigation for persistent hematospermia.

METHODSIncluded in the study were 12 patients with persistent hematospermia, aged (36.4 +/- 10.8) years, and with a course of the disease of (13.9 +/- 6.4) months. After the expressed prostatic secretion (EPS) by prostatic massage cultured, the patients received TRUS-guided transperineal needle aspiration for seminal vesicle fluid (SVF) for bacteriological examination. For the EPS positive patients, antibiotics were selected according to the drug sensitivity assay and injected into the abnormal seminal vesicle (SV) via TRUS-guided transperineal needle puncture. The treatment was repeated one month later for those still with hematospermia. The patients were followed up every three months.

RESULTSAbnormal images were found in the SV and/or ejaculatory duct in 9 cases, including SV and/or ejaculatory duct dilation, SV wall thickening, calcification or calculi of SV, and müllerian duct cyst. SVF cultures were positive in 7 cases, including 4 cases of methicillin-resistant Staphylococcus aurous (MRSA), 1 case of methicillin-resistant coagulase-negative staphylococcus (MRCNS), 1 case of E. Coli, and 1 case of Proteus mirabili. All the patients were treated by TRUS-guided transperineal injection of certain antibiotics into SV. Ten of them were followed up for (31.4 +/- 5.7) months. Hematospermia disappeared in 3 cases and relapsed at least once in the other 7. The last follow-up showed hematospermia recurrence in 2 cases.

CONCLUSIONTRUS-guided transperineal irrigation of antibiotics into SV is effective to a certain extent for persistent hematospermia.