Clinical case
Prostatic cyst: An unusual cause of hemospermia
F. Hernández-Galván
, R. Jaime-Dávila, L.S. Gómez-Guerra, A. Gutiérrez-González, J.F. Lozano-Salinas, J.G. Arrambide-Gutiérrez
Corresponding author
ferher98@yahoo.com
Corresponding author at: Servicio de Urología del Hospital Universitario “Dr. José Eleuterio González” de la Universidad Autónoma de Nuevo León, Av. Francisco I. Madero s/n, Col. Mitras Centro, Monterrey, NL CP 64460, Mexico. Tel.: +52 81 83331713.
Corresponding author at: Servicio de Urología del Hospital Universitario “Dr. José Eleuterio González” de la Universidad Autónoma de Nuevo León, Av. Francisco I. Madero s/n, Col. Mitras Centro, Monterrey, NL CP 64460, Mexico. Tel.: +52 81 83331713.
Urology Service at the “Dr. José Eleuterio González” University Hospital and School of Medicine of the Autonomous University of Nuevo León, Mexico
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Gómez-Guerra, A. Gutiérrez-González, J.F. Lozano-Salinas, J.G. Arrambide-Gutiérrez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Hernández-Galván" "email" => array:1 [ 0 => "ferher98@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Jaime-Dávila" ] 2 => array:2 [ "nombre" => "L.S." "apellidos" => "Gómez-Guerra" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Gutiérrez-González" ] 4 => array:2 [ "nombre" => "J.F." "apellidos" => "Lozano-Salinas" ] 5 => array:2 [ "nombre" => "J.G." "apellidos" => "Arrambide-Gutiérrez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Urology Service at the “Dr. José Eleuterio González” University Hospital and School of Medicine of the Autonomous University of Nuevo León, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Servicio de Urología del Hospital Universitario “Dr. José Eleuterio González” de la Universidad Autónoma de Nuevo León, Av. Francisco I. Madero s/n, Col. Mitras Centro, Monterrey, NL CP 64460, Mexico. Tel.: +52 81 83331713." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1023 "Ancho" => 1499 "Tamanyo" => 156160 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transurethral resection: (a) before; (b) during; (c) post-resection.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Prostatic cysts, although an infrequent diagnosis in men, are usually asymptomatic and mostly detected incidentally during abdominal or transrectal ultrasonography. Etiological factors include chronic prostatitis as a cause of lateral prostatic cysts and congenital disease as a cause of midline cysts. Existent scientific publications on prostatic cysts are mostly isolated case reports, which highlights their uncommon occurrence and even lower propensity for causing symptoms.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> We report a case of a benign prostatic cyst with hemospermia.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A young 31-year-old male was presented to us with hemospermia with a duration of more than 4 years. Consecutive hemospermia was present in each ejaculation with abundant blood clots. There were no others symptoms like perineal pain, fever, dysuria, nocturia or urgency. No urinary tract infection or prostatic infection was reported.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Initial evaluation included a urine microscopic analysis, semen culture, and a screening abdominal ultrasonography, which documented the presence of a prostatic cyst. A CT scan was performed to evaluate the seminal vesicles and a small calcification was found in the right seminal vesicle (not shown). His sperm count was 36<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span> sperm per milliliter (normal 15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>) with 10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span> sperm in the total count (normal 39<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>), the progressive motility was 55% (normal 32%), white blood cells was 1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span> (normal 1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>) and red blood cells were abundant (normal 0<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>). After the surgery, the semen analysis parameters were sperm count 33<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span> sperm per milliliter, with 99<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span> sperm in the total count, the progressive motility was 54%, white blood cells was 1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>, and red blood cells 0<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>. The patient was initially managed with antibiotic therapy. A retrograde urethrogram did not reveal any communication with the prostatic cyst.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent cystoscopy and transurethral resection of the prostatic cyst (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Back pressure changes were noted in this case. The roof of the cyst was resected with minimal coagulation under direct vision with a wire loop to marsupialize the cyst. Care was taken to spare the bladder neck and verumontanum to prevent retrograde ejaculation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The resection resulted in drainage of a clear fluid. Cold-cup biopsies taken from the cyst wall revealed non-urothelial epithelium with no preneoplastic changes. A 16<span class="elsevierStyleHsp" style=""></span>F Foley catheter was placed overnight and the patient was discharged the next morning. Follow-up at one, three and six months demonstrated unobstructed urinary flow and normal ejaculation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Prostatic cysts include the utricle cyst, the Müllerian duct cyst, the hemorrhagic prostatic cyst, the hydatid cyst, and cysts associated with prostatitis. Our patient had a lateral cyst near the bladder neck in the right side and another small cyst in the left side. He was concerned about his hemospermia, because there was more than before in each event and this was the reason he came to the hospital. The patient never referred to pelvic pain, dysuria or perineal pain; his only symptom was hemospermia. He had no infertility problem (he had 2 children, aged 6 and 4). After the surgery and to date, he has never presented hemospermia again, and his sperm count parameters are normal. Some cysts are primarily prostatic glandular in origin and are acquired later in life. Most lateral prostatic cysts are related to chronic prostatitis.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> Symptomatic prostatic cysts are a cause of chronic pelvic pain, upper or lower urinary tract infection (UTI), infertility, hemospermia and, rarely, malignancy.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–6</span></a> In our case the only symptom was hemospermia, no infertility and no pelvic or perineal pain were present.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some therapeutic options for managing prostatic cysts include transrectal aspiration with or without sclerotherapy, transurethral marsupialization, and open surgery. Some authors report durable recurrence-free results in a series of patients with medial prostatic cysts treated with transurethral incision.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,7</span></a> We treated this patient by means of a transurethral marsupialization and fulguration of the vessels. This lead to full recuperation, and the patient was discharged the next day without pain and he had an uneventful recovery.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Valuable information was obtained by performing a cistourethroscopy, demonstrating that the vessels ran over the cyst, which is by itself an unusual finding. This was important because hemospermia is usually treated only with antibiotics. In our case, the solution was marsupialization of the cyst and fulguration of the dilated vessels.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">No financial support was provided.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres635421" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec647939" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-27" "fechaAceptado" => "2015-05-12" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec647939" "palabras" => array:3 [ 0 => "Hemospermia" 1 => "Intraprostatic cyst" 2 => "Transurethral marsupialization" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 31-year-old man was referred to our service because of recurrent hemospermia over the last 4 years, there were no other symptoms like perineal pain, fever, dysuria, nocturia or urgency; this patient only presented hemospermia with clots. Genital examination was normal. Semen analysis showed no change in volume and pH; however, hemospermia and asthenozoospermia were observed. The semen culture was normal. Ultrasonography only revealed the presence of a cystic lesion adjoining the prostate gland, next to the bladder neck. The retrograde urethrogram was normal. The CT scan revealed only a small calcification in the right seminal vesicle. Endoscopic cistourethroscopy demonstrated 2 cystic dilatations arising on both sides of the prostate gland adjacent to the bladder neck, behind the verumontanum with vessels running over the surface prostatic cyst dilatation. The diagnosis of prostatic gland cystic dilatation was reached and confirmed by pathology that reported fibroconnective tissue with fibrosis and hyalinization. Transurethral unroofing of the cyst was performed separately with a successful outcome.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 473 "Ancho" => 1500 "Tamanyo" => 80354 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cystoscopy image. Blood vessels are visible.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1023 "Ancho" => 1499 "Tamanyo" => 156160 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transurethral resection: (a) before; (b) during; (c) post-resection.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Midline prostatic cyst in a young man with lower urinary tract symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Saha" 1 => "R.K. Sinha" 2 => "S. Mukherjee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2014-207816" "Revista" => array:2 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and management of anterior intraurethral prostatic cyst" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.M. Issa" 1 => "J. Kalish" 2 => "J.A. 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Schrier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1996" "volumen" => "155" "paginaInicial" => "1301" "paginaFinal" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8632560" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papillary cystadenoma in a mullerian duct cyst: report of a case with review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.P. Xing" 1 => "J.G. Dang" 2 => "D. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Zhonghua Nan Ke Xue" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "218" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16597035" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transrectal ultrasound in the investigation of hematospermia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.J. Etherington" 1 => "R. Clements" 2 => "G.J. 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Jarow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Tech Urol" "fecha" => "1996" "volumen" => "2" "paginaInicial" => "79" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9118414" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16655796/0000001700000068/v1_201605130035/S1665579615000447/v1_201605130035/en/main.assets" "Apartado" => array:4 [ "identificador" => "42852" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/16655796/0000001700000068/v1_201605130035/S1665579615000447/v1_201605130035/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579615000447?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 492 | 5 | 497 |
| 2024 September | 1003 | 28 | 1031 |
| 2024 August | 1083 | 21 | 1104 |
| 2024 July | 1537 | 25 | 1562 |
| 2024 June | 755 | 17 | 772 |
| 2024 May | 929 | 12 | 941 |
| 2024 April | 1119 | 18 | 1137 |
| 2024 March | 984 | 17 | 1001 |
| 2024 February | 1344 | 31 | 1375 |
| 2024 January | 1620 | 13 | 1633 |
| 2023 December | 1522 | 19 | 1541 |
| 2023 November | 1259 | 16 | 1275 |
| 2023 October | 1611 | 23 | 1634 |
| 2023 September | 1524 | 14 | 1538 |
| 2023 August | 1666 | 15 | 1681 |
| 2023 July | 1686 | 19 | 1705 |
| 2023 June | 1583 | 21 | 1604 |
| 2023 May | 1598 | 23 | 1621 |
| 2023 April | 847 | 10 | 857 |
| 2023 March | 1422 | 10 | 1432 |
| 2023 February | 1064 | 9 | 1073 |
| 2023 January | 667 | 9 | 676 |
| 2022 December | 556 | 17 | 573 |
| 2022 November | 1257 | 19 | 1276 |
| 2022 October | 1012 | 27 | 1039 |
| 2022 September | 1123 | 21 | 1144 |
| 2022 August | 1030 | 34 | 1064 |
| 2022 July | 661 | 11 | 672 |
| 2022 June | 499 | 16 | 515 |
| 2022 May | 489 | 18 | 507 |
| 2022 April | 574 | 18 | 592 |
| 2022 March | 618 | 32 | 650 |
| 2022 February | 563 | 14 | 577 |
| 2022 January | 488 | 13 | 501 |
| 2021 December | 556 | 25 | 581 |
| 2021 November | 612 | 18 | 630 |
| 2021 October | 768 | 15 | 783 |
| 2021 September | 684 | 18 | 702 |
| 2021 August | 853 | 14 | 867 |
| 2021 July | 604 | 10 | 614 |
| 2021 June | 515 | 13 | 528 |
| 2021 May | 476 | 14 | 490 |
| 2021 April | 1024 | 28 | 1052 |
| 2021 March | 607 | 16 | 623 |
| 2021 February | 409 | 10 | 419 |
| 2021 January | 437 | 22 | 459 |
| 2020 December | 258 | 12 | 270 |
| 2020 November | 156 | 14 | 170 |
| 2020 October | 93 | 13 | 106 |
| 2020 September | 75 | 14 | 89 |
| 2020 August | 82 | 13 | 95 |
| 2020 July | 67 | 8 | 75 |
| 2020 June | 64 | 16 | 80 |
| 2020 May | 63 | 17 | 80 |
| 2020 April | 38 | 9 | 47 |
| 2020 March | 59 | 9 | 68 |
| 2020 February | 52 | 6 | 58 |
| 2020 January | 35 | 19 | 54 |
| 2019 December | 33 | 15 | 48 |
| 2019 November | 45 | 11 | 56 |
| 2019 October | 49 | 8 | 57 |
| 2019 September | 55 | 9 | 64 |
| 2019 August | 72 | 10 | 82 |
| 2019 July | 40 | 18 | 58 |
| 2019 June | 64 | 21 | 85 |
| 2019 May | 123 | 44 | 167 |
| 2019 April | 51 | 27 | 78 |
| 2019 March | 21 | 4 | 25 |
| 2019 February | 27 | 4 | 31 |
| 2019 January | 16 | 3 | 19 |
| 2018 December | 21 | 6 | 27 |
| 2018 November | 33 | 5 | 38 |
| 2018 October | 30 | 6 | 36 |
| 2018 September | 28 | 6 | 34 |
| 2018 August | 8 | 1 | 9 |
| 2018 July | 12 | 1 | 13 |
| 2018 June | 14 | 1 | 15 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 16 | 0 | 16 |
| 2018 March | 11 | 3 | 14 |
| 2018 February | 9 | 0 | 9 |
| 2018 January | 12 | 1 | 13 |
| 2017 December | 7 | 2 | 9 |
| 2017 November | 10 | 1 | 11 |
| 2017 October | 9 | 4 | 13 |
| 2017 September | 8 | 1 | 9 |
| 2017 August | 11 | 1 | 12 |
| 2017 July | 14 | 3 | 17 |
| 2017 June | 20 | 29 | 49 |
| 2017 May | 26 | 8 | 34 |
| 2017 April | 11 | 3 | 14 |
| 2017 March | 15 | 10 | 25 |
| 2017 February | 15 | 6 | 21 |
| 2017 January | 13 | 0 | 13 |
| 2016 December | 25 | 11 | 36 |
| 2016 November | 23 | 2 | 25 |
| 2016 October | 27 | 9 | 36 |
| 2016 September | 42 | 11 | 53 |
| 2016 August | 33 | 3 | 36 |
| 2016 July | 26 | 2 | 28 |
| 2016 June | 23 | 9 | 32 |
| 2016 May | 25 | 14 | 39 |
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