The comprehensive analysis of bi-parametric magnetic resonance imaging in the diagnosis and treatment of hematospermia
Objective To investigate the value of bi-parameter magnetic resonance imaging(bpMRI)in diagnosis and treatment of hematospermia.Methods The clinical data and bpMRI of 182 patients with hematospermia(hematospermia group)and 51 patients without urinary system diseases(control group)were retrospectively analyzed.Both the control group and the hematospermia group underwent semen quality analysis,blood routine,urine routine,coagulation function,serum PSA test,and bpMRI examination before treatment.There were no significant differences in age[40(33,50)years vs.39(31,53)years,Z=-0.77,P=0.43],body mass index[23.9(22.0,25.7)kg/m2 vs.24.5(22.3,26.1)kg/m2,Z=-0.50,P=0.62],smoking rate[24.7％(45/182)vs.27.5％(14/51),x2=0.16,P=0.69],alcohol consumption rate[29.1％(53/182)vs.29.4％(15/51),x2=0.002,P=0.97],and comorbid hypertension[20.9％(38/182)vs.17.6％(9/51),x2=0.26,P=0.61]between the hematospermia group and the control group.There was a statistically significant difference in PSA levels between the hematospermia group and the control group[2.82(2.08,3.68)ng/ml vs 1.59(0.88,2.28)ng/ml,Z=6.08,P=0.03].The median duration of illness in the hematospermia group was 10(5,15)months,the median number of red blood cells reported in semen analysis was 17(10,23)/HP,59(32.4％)cases had infections in urine routine results,15(8.2％)cases had infections in blood routine results,and 19(10.4％)cases had coagulation abnormalities.Hematospermia patients can be divided into five categories based on their causes:105 cases of infection and inflammation,42 cases of obstruction,19 cases of tumors,8 cases of systemic diseases,and 8 cases of iatrogenic factors and trauma.The treatment option was based on etiology:①Infections,Inflammation,Systemic Diseases,Iatrogenic Factors,and Trauma:Remove the underlying cause and observe or watchful waiting.②Recurrence of Systemic Diseases,Infections,and Inflammation:Treat the underlying cause with appropriate medication,including nonsteroidal anti-inflammatory drugs(NSAIDs),α-receptor blockers,etc.If there is an infection,administer oral antibiotics for 1-2 weeks.③Obstruction and Tumors:Perform seminal vesiculoscopy surgery or radical prostatectomy.The efficacy evaluation was porfeomed after 12 months of treatment.Cure:Hematospermia symptoms disappear,with no recurrence.Effective:Symptoms significantly improve,no visible hematospermia,semen analysis shows marked improvement in red blood cells,and neither clinical symptoms nor semen analysis worsen.Not Cured:Visible hematospermia persists,and semen analysis shows no change in red blood cells compared to before treatment.Recurrence:Clinical symptoms improve but significant visible hematospermia reappears,and semen analysis shows red blood cell count＞5/HP.Results The proportion of patients with PI-RADS scores ≥ 3 in the hematospermia group was higher than that in the control group[29.1％(53/182)vs.13.7％(7/51),x2=4.94,P=0.03],and the difference was statistically significant.Comparing the imaging characteristics and related parameters of two groups of bpMRI,the results showed that the length and width of the left and right seminal vesicles in the hematospermia group were greater than those in the control group.The length of the left seminal vesicle was[29.9(25.9,33.4)mm vs.23.0(21.2,25.4)mm,Z=7.30,P＜0.01],the width of the left seminal vesicle was[20.4(17.8,23.5)mm vs.17.2(15.1,18.5)mm,Z=5.85,P＜0.01],the length of the right seminal vesicle was[28.9(24.8,32.4)mm vs.23.4(21.5,28.1)mm,Z=4.68,P＜0.01],and the width of the right seminal vesicle was[19.8(17.7,23.1)mm vs.17.2(15.1,18.6)mm,Z=5.45,P＜0.01].The differences were statistically significant.After 12 months of follow-up,152(83.5％)cases were cured,21(11.5％)cases were defined as effective,4(2.2％)cases were not cured,and 5(2.7％)cases had recurrence.Conclusions The bpMRI examination can clearly identify the location of the hematospermia lesion and the timing of the bleeding.Based on the results of bpMRI,determining the cause and selecting the appropriate treatment strategy is reliable,convenient,and effective.
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