Urothelial Carcinoma Presenting as Single Episode of Haematospermia: A Case Report and Review of Literature

Background: Some people are of the opinion that single episodes of haematospermia should not be thoroughly investigated because usually no significant pathology is found. This attitude towards single episodes of haematospermia may leave some patients with treatable pathology undiagnosed for a considerable length of time and could be considered by others a negligent attitude if the pathology is subsequently diagnosed. Aims: To report a case of transitional cell carcinoma of the urinary bladder diagnosed during investigation of a single episode of haematospermia. To review the literature on haematospermia Case Report: A 32-years-old man was referred because of a single episode of haematospermia. His investigations including: urine microscopy and culture; urine cytology; full blood count; ultrasound scan of the urinary tract were normal. He had flexible cystoscopy which revealed a 5 mm papillary tumour in his urinary bladder. He underwent trans-urethral resection of the bladder tumour; histological examination revealed a well differentiated papillary without any evidence of invasion. He underwent flexible review cystoscopies at 3 monthly intervals for a year which revealed no evidence of recurrence. Discussion: There is evidence in the literature to suggest that: (a) Episodes of haematospermia in patients less than 40 years old are usually benign. (b) Mal ignancies occur in 2% of cases of haematospermia (c) There is a school of thought with the opinion that single episodes of haematospermia should be treated in the community without the need for ultrasound scan of the urinary tract or cystoscopy. Conclusions: The finding of a papillary transitional cell carcinoma of the urinary bladder in a 32-years-old man with a single episode of haematospermia should make all practitioners weigh the pros and cons of full investigation of patients with single episodes of haematospermia. Decision whether or not to investigate a single episode of haematospermia should be taken based upon other aspects of the patient’s history (This patient is a smoker). It is the author’s opinion that every patient with a single episode of haematospermia should be investigated fully and quickly and if no pathology is found the patient can be discharged. This is the only way one can quickly diagnose any pathology that the patient may have. Rarity of pathology should not provide the chance for any practitioner to miss the early diagnosis of a potentially treatable condition by not ful ly invest igat ing single episodes of haematospermia.