Hyperuricemia May Have a Role in Hematospermia

VANCOUVER—Patients with hematospermia may have hyperuricemia as the underlying cause, according to study findings presented at presented at the 33rd Congress of the Societé Internationale d'Urologie

The study included 143 patients who presented with refractory hematospermia for more than three months at the urology clinic at the Assiut University Hospital in Assiut, Egypt, from July 2005 to July 2012. Adel Kurkar, MD, and three other researchers directed their assessments of the patients based on history and clinical findings ranging from urinalysis to the results of transrectal ultrasound (TRUS) with or without biopsy. Treatment was administered and the patients' semen was subsequently analyzed once a month until the symptoms resolved; thereafter, the semen was analyzed every three months for one year.

Twenty-two (15.38%) of the patients were found to have hyperuricemia, representing the second-most-common comorbidity with hematospermia. Schistosomiasis was present in 31 patients, 21 had idiopathic hematospermia, 12 each had tuberculosis and chronic prostatitis, and the remaining had other causes of hematospermia.

“We were surprised with this finding of a high prevalence of hyperuricemia,” remarked co-investigator Ahmad Abdelaziz Elderwy, MD, a urologist at the Assiut University Hospital and a pediatric urology fellow at the Seattle Children's Hospital. “I recommend that patients with both hematospermia and hyperuricemia be sent to a rheumatologist for further evaluation.”

The 22 patients' mean age at presentation was 32 years (range 20-48) and they had between five and 12 hematospermia attacks over two to six months before going to the hospital. Their mean serum uric acid level at the initial assessment was 9.2 mg/dL (range 7.6-11.4).

Fourteen (63.6%) of the hyperuricemia patients also had lower urinary tract symptoms, 15 had painful ejaculation, 12 had arthralgia, 10 had urate crystals in their urine, seven had urate crystals in their semen. In five patients, TRUS revealed dotted prostate calcifications.

All of the hyperuricemia patients were treated with allopurinol 300 mg tablets twice daily for eight weeks, followed by 300 mg daily until the condition was no longer present. The patients experienced complete resolution of hyperuricemia and hematospermia within an average of two months (range one to four months).

“Randomized studies are still needed to confirm our data,” commented co-investigator Sherif Abulsorour, MD. In the meantime, he and his colleagues recommend that clinicians estimate serum uric acid in men presenting with hematospermia, particularly those with symptoms that are suggestive of gout.

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