Hematospermia / Haematospermia — Core Meaning
Hematospermia মানে semen/ejaculate-এর মধ্যে রক্ত থাকা। এটি নিজে একটি disease না; বরং prostate, seminal vesicle, urethra, epididymis/testis বা systemic bleeding problem-এর symptom। বেশিরভাগ young patient-এ এটি benign ও self-limited, তবে age ≥40, recurrent/persistent episode, hematuria, fever, weight loss, bone pain, abnormal DRE/PSA থাকলে prostate/urogenital malignancy ও serious infection exclude করতে হবে।
1. Definition — সংজ্ঞা
Hematospermia = ejaculation-এর সময় semen-এ visible বা microscopic blood থাকা। Semen pink/red/brown/coffee-colored হতে পারে। রোগী অনেক সময় এটাকে hematuria বা partner-এর vaginal bleeding ভেবে ভুল করতে পারেন, তাই true hematospermia vs pseudo-hematospermia আলাদা করা জরুরি।
2. Etiology / Causes — কারণগুলো
A. Common benign causes
1. Idiopathic / no cause found
অনেক ক্ষেত্রে specific cause পাওয়া যায় না; এক-দুই episode নিজে নিজে ভালো হয়ে যায়।
2. Infection / inflammation
Prostatitis, seminal vesiculitis, urethritis, epididymitis, UTI, STI—বিশেষ করে Chlamydia, Gonorrhea, Mycoplasma, Trichomonas। Young sexually active male-এ LUTS বা urethral discharge থাকলে STI consider করতে হবে।
3. Recent vigorous sex / prolonged abstinence
Long abstinence বা vigorous intercourse/masturbation-এর পর accessory sex gland-এর small vessel rupture হতে পারে।
4. Trauma / iatrogenic
Prostate biopsy, catheterization, cystoscopy, vasectomy, instrumentation—age ≥40 group-এ common কারণ।
B. Urological structural causes
5. BPH / prostatic congestion
Benign prostatic hyperplasia-এ fragile prostatic vessels থেকে bleeding হতে পারে।
6. Stones / cyst / obstruction
Prostatic calculi, seminal vesicle stone/cyst, ejaculatory duct obstruction, utricle cyst—persistent or recurrent hematospermia করতে পারে।
7. Vascular abnormality
Prostatic urethral hemangioma, varices, vascular malformation—rarely heavy bleeding করতে পারে।
C. Serious causes to exclude
8. Malignancy
Prostate cancer, seminal vesicle tumor, testicular tumor, bladder/urethral tumor—rare, but age ≥40, abnormal DRE/PSA, weight loss/bone pain থাকলে workup জরুরি।
9. Systemic disease
Severe hypertension, liver disease, leukemia/lymphoma, thrombocytopenia, bleeding disorder, anticoagulant/antiplatelet use.
10. TB / schistosomiasis
Bangladesh context-এ chronic/recurrent case, sterile pyuria, constitutional symptoms, TB history থাকলে genitourinary TB consider করা উচিত।
3. Symptoms — লক্ষণগুলো
Hematospermia-তে মূল complaint হলো বীর্যে রক্ত। সাথে কারণ অনুযায়ী এগুলো থাকতে পারে:
- Semen pink/red/brown/blackish — fresh blood হলে red/pink, old blood হলে brown/coffee color।
- Painful ejaculation — prostatitis, seminal vesiculitis বা ejaculatory duct obstruction suggest করে।
- Dysuria / burning micturition — urethritis, UTI, prostatitis।
- Frequency, urgency, suprapubic pain — lower urinary tract infection/BPH।
- Urethral discharge — STI, especially gonorrhea/chlamydia।
- Perineal/pelvic pain, low back pain — prostatitis/CPPS।
- Testicular pain/swelling — epididymitis/orchitis; torsion exclude করতে হবে।
- Fever, chills, malaise — acute bacterial prostatitis/epididymo-orchitis; urgent care দরকার।
- Hematuria — separate hematuria pathway; cystoscopy/CT urogram may be needed।
- Weight loss, anorexia, bone pain — malignancy red flag।
4. Clinical Diagnosis — কীভাবে clinically diagnosis করবেন
A. First clinical sorting
Low-risk hematospermia:
Age <40, first/limited episode, no fever, no hematuria, no LUTS/STI symptom, no cancer/bleeding risk → reassurance + minimal tests.
High-risk hematospermia:
Age ≥40, recurrent/persistent >1 month or repeated episodes, hematuria, fever, severe pain, abnormal DRE, high PSA, family history prostate cancer, weight loss/bone pain, anticoagulant use → urology referral + full workup.
B. History — specific points
- Episode সংখ্যা, duration, semen color, clot আছে কি না
- Hematuria আছে কি না
- Dysuria, frequency, urgency, urethral discharge
- Painful ejaculation, pelvic/perineal pain
- Scrotal/testicular pain/swelling
- Fever/chills
- Recent sex, abstinence, trauma, masturbation, instrumentation, biopsy
- STI risk: new/multiple partner, condom use
- TB history, weight loss, night sweat
- Anticoagulant/antiplatelet: warfarin, rivaroxaban, apixaban, aspirin, clopidogrel
- Hypertension, liver disease, bleeding tendency
C. Physical examination
- BP + temperature — severe hypertension/infection screen।
- Abdominal exam — suprapubic tenderness, bladder retention।
- Genital exam — urethral meatus, discharge, penile lesion।
- Testis/epididymis exam — tenderness, swelling, mass।
- DRE — prostate tender হলে prostatitis; hard nodule/asymmetry হলে malignancy suspicion।
- Lymph node + systemic exam — malignancy/hematologic disease clue।
5. Investigations — specific workup
Basic tests
- Urine R/M/E + microscopy — RBC, pus cell, nitrite/leukocyte।
- Urine culture & sensitivity — UTI/prostatitis suspicion।
- First-catch urine NAAT for Chlamydia/Gonorrhea — STI risk, urethral discharge, young male। CDC/EAU both NAAT-guided STI diagnosis support করে।
- CBC + platelet count — anemia, thrombocytopenia, leukemia clue।
- PT/INR, aPTT — anticoagulant use/bleeding disorder।
- Serum creatinine, LFT — before antibiotic/NSAID; liver disease/renal risk।
- PSA — age >40, abnormal DRE, recurrent/persistent case; active prostatitis থাকলে PSA falsely raised হতে পারে, তাই infection settle হওয়ার পর repeat করা ভালো।
Cause-specific tests
- Semen analysis/culture — recurrent/persistent prostatitis/seminal vesiculitis suspicion; routine single episode-এ দরকার নেই।
- TRUS — transrectal ultrasound — persistent/recurrent hematospermia; seminal vesicle cyst, stone, ejaculatory duct obstruction, abscess।
- Scrotal ultrasound — testicular pain/swelling/mass।
- MRI prostate/pelvis — recurrent unexplained case, abnormal PSA/DRE, suspected seminal vesicle/prostate lesion।
- Cystoscopy ± CT urogram — hematuria, urethral bleeding, age ≥40 with persistent symptom, suspected bladder/urethral pathology।
- AFB urine/semen, GeneXpert/urine AFB culture — TB suspicion।
- HIV, syphilis, HBV/HCV testing — STI risk profile অনুযায়ী; CDC epididymitis guideline STI-associated cases-এ HIV/syphilis testing recommend করে।
6. Differential Diagnosis — কী কী আলাদা করতে হবে
- Pseudo-hematospermia — partner-এর menstrual/vaginal bleeding।
- Hematuria — urine-এ blood, semen না।
- Urethral bleeding — ejaculation ছাড়াই urethra থেকে blood।
- Prostatitis / seminal vesiculitis
- Urethritis / STI
- Epididymitis / orchitis
- BPH
- Prostate cancer / bladder cancer / testicular tumor
- Bleeding disorder / anticoagulant effect
- Trauma or post-procedure bleeding
7. Complications — রোগীর ভাষায় বুঝিয়ে
বেশিরভাগ hematospermia dangerous না, কিন্তু cause untreated থাকলে complication হতে পারে:
- Recurrent anxiety and sexual avoidance — patient ও partner-এর fear, relationship stress।
- Untreated STI — epididymitis, infertility risk, partner transmission।
- Acute prostatitis complication — sepsis, urinary retention, prostatic abscess।
- Epididymo-orchitis complication — abscess, chronic scrotal pain, subfertility।
- Missed malignancy — age ≥40/recurrent case-এ prostate/bladder/testicular tumor miss হতে পারে।
- Anemia — massive/recurrent bleeding হলে rare।
- Drug complication — unnecessary antibiotic/NSAID use করলে resistance, GI bleed, renal injury, QT prolongation, tendon injury ইত্যাদি।
8. Treatment / Management — guideline-based
A. General management
Single episode, age <40, no red flag:
Reassurance, avoid vigorous sex for 1–2 weeks, hydration, treat only if infection/STI evidence আছে। AAFP অনুযায়ী young low-risk patient-এ minimal workup + reassurance যথেষ্ট।
Persistent/recurrent or age ≥40:
Urine tests + PSA/DRE + imaging/referral. Hematuria থাকলে hematuria pathway।
9. Pharmacological treatment — generic, dose, purpose, side effect, interaction, Bangladesh brands
Important: Hematospermia-তে blind antibiotic দেওয়া ঠিক না। Fever, LUTS, STI risk, positive urine/NAAT/culture, prostatitis/epididymitis signs থাকলে antibiotic indicated. Fluoroquinolone resistance ও serious adverse effects মাথায় রেখে culture-guided therapy better; EAU guideline fluoroquinolone adverse-effect warning উল্লেখ করেছে।
1) Ibuprofen
Generic name: Ibuprofen
Therapeutic category: Analgesic, antipyretic, anti-inflammatory
Pharmacological class: NSAID; non-selective COX inhibitor
Why used: Painful ejaculation, pelvic discomfort, mild inflammatory pain; infection না থাকলে short course symptomatic relief।
Adult dose: 400 mg orally 2–3 times daily after food for 3–5 days; avoid long course.
Common side effects: Gastritis, dyspepsia, GI bleeding, renal impairment, BP rise, bronchospasm in NSAID-sensitive asthma.
Important interactions: Warfarin/DOAC/aspirin/clopidogrel → bleeding risk; ACEI/ARB + diuretic → AKI risk; steroid/SSRI → GI bleed risk.
Bangladesh available brand examples: Profen 400 mg, Intaflam 400 mg, Reumafen 400 mg, Flam 400 mg, Iburex 400 mg, Iben 400 mg.
2) Naproxen
Generic name: Naproxen sodium
Therapeutic category: Analgesic/anti-inflammatory
Pharmacological class: NSAID
Why used: Prostatitis/seminal vesiculitis-related pelvic pain, testicular inflammatory pain—antibiotic adjunct, not curative.
Adult dose: 250–500 mg orally twice daily after food for 3–7 days.
Side effects: Gastritis, ulcer/GI bleeding, renal injury, edema, BP increase.
Interactions: Anticoagulants/antiplatelets, steroid, SSRI, lithium, methotrexate, ACEI/ARB/diuretic.
Bangladesh available brand examples: Naprox 500 mg, Napryn 500 mg, Naproxin 500 mg, Naxo 500 mg, Napsod 550 mg.
3) Doxycycline
Generic name: Doxycycline
Therapeutic category: Antibiotic
Pharmacological class: Tetracycline antibiotic
Why used: Suspected/confirmed Chlamydia urethritis, STI-associated hematospermia, chronic bacterial prostatitis due to intracellular pathogens. CDC gonorrhea regimen-এ chlamydia not excluded হলে doxycycline 100 mg BD 7 days; epididymitis regimen-এ 10 days। EAU CBP-তে doxycycline 100 mg BD 10 days for C. trachomatis/mycoplasma।
Adult dose: 100 mg orally twice daily for 7–10 days; chronic prostatitis cause-specific হলে 10 days or specialist-guided.
Side effects: Nausea, esophagitis, photosensitivity, diarrhea.
Interactions: Antacid/iron/calcium/zinc/milk reduce absorption; warfarin effect may increase; isotretinoin → intracranial hypertension risk.
Bangladesh available brand examples: Doxin 100 mg, Doxy-A 100 mg, Ipadox 100 mg, Doxigen 100 mg, Doxylin 100 mg, Doxysina 100 mg.
4) Ceftriaxone
Generic name: Ceftriaxone sodium
Therapeutic category: Injectable antibiotic
Pharmacological class: 3rd generation cephalosporin
Why used: Suspected/confirmed gonorrhea, STI-associated epididymitis/urethritis, severe urogenital infection. CDC uncomplicated gonorrhea: ceftriaxone 500 mg IM single dose if <150 kg; ≥150 kg হলে 1 g। Chlamydia exclude না হলে doxycycline add।
Adult dose:
- Gonorrhea: 500 mg IM single dose; ≥150 kg: 1 g IM single dose.
- Epididymitis due to STI: 500 mg IM once + doxycycline 100 mg BD 10 days.
Side effects: Injection pain, diarrhea, allergy, biliary sludge, rare anaphylaxis.
Interactions: Calcium-containing IV solution avoid in neonates; warfarin bleeding risk may increase.
Bangladesh available brand examples: Ceftron 500 mg/1 g, Ceftizone 500 mg/1 g, Oricef 500 mg/1 g, Traxef 500 mg/1 g, Imacef 1 g, G-Ceftriax 500 mg.
5) Levofloxacin
Generic name: Levofloxacin
Therapeutic category: Antibiotic
Pharmacological class: Fluoroquinolone
Why used: Enteric organism-related epididymitis, bacterial prostatitis/UTI with prostatic involvement—preferably culture-guided. CDC epididymitis: enteric organism only হলে levofloxacin 500 mg daily 10 days; EAU chronic bacterial prostatitis-এ fluoroquinolone 4–6 weeks first line.
Adult dose:
- Epididymitis enteric: 500 mg orally once daily for 10 days.
- Chronic bacterial prostatitis: 500 mg once daily for 4–6 weeks, culture-guided.
Side effects: Nausea, diarrhea, QT prolongation, tendinitis/tendon rupture, neuropathy, CNS effects, dysglycemia.
Interactions: Antacid/iron/zinc/calcium reduce absorption; QT-prolonging drugs; warfarin; steroid increases tendon risk.
Bangladesh available brand examples: Levoxin 500 mg, Levox 500 mg/100 ml IV, Genolev 500 mg, Levobac 500 mg, Levora 500 mg.
6) Ciprofloxacin
Generic name: Ciprofloxacin
Therapeutic category: Antibiotic
Pharmacological class: Fluoroquinolone
Why used: Culture-confirmed UTI/prostatitis due to susceptible Gram-negative organism; chronic bacterial prostatitis-এ EAU fluoroquinolone option। Gonorrhea empiric treatmentে ciprofloxacin ব্যবহার করা উচিত না, unless susceptibility confirmed.
Adult dose: 500 mg orally twice daily; prostatitis হলে usually 4–6 weeks specialist/culture-guided.
Side effects: GI upset, tendinopathy, QT prolongation, neuropathy, CNS effects, photosensitivity.
Interactions: Antacid/iron/zinc/calcium, theophylline toxicity, warfarin, QT drugs, steroid.
Bangladesh available brand examples: Ciprocin 500 mg, Ciprox 500 mg, Ciprozid-DS 500 mg, Civox 500 mg, Ranflox 500 mg, Cip 500 mg.
7) Azithromycin
Generic name: Azithromycin
Therapeutic category: Antibiotic
Pharmacological class: Macrolide
Why used: Intracellular pathogens in chronic bacterial prostatitis or STI alternative when doxycycline unsuitable; EAU recommends macrolide when intracellular bacteria identified. Not routine hematospermia medicine.
Adult dose: Cause-specific: 500 mg once daily up to 3 weeks for C. trachomatis CBP per EAU; STI regimens vary by organism/resistance pattern.
Side effects: Nausea, diarrhea, abdominal pain, QT prolongation, cholestatic hepatitis rare.
Interactions: QT-prolonging drugs, warfarin monitoring, digoxin level may increase.
Bangladesh available brand examples: Ranzith 500 mg, Azinil 500 mg, Azirox 500 mg, Simpli-3 500 mg, Verizith 500 mg.
8) Metronidazole
Generic name: Metronidazole
Therapeutic category: Antiprotozoal/anaerobic antibiotic
Pharmacological class: Nitroimidazole
Why used: Trichomonas vaginalis infection-related urethritis/prostatitis; EAU CBP table: metronidazole 500 mg TDS 14 days for T. vaginalis CBP.
Adult dose: 500 mg orally three times daily for 14 days when T. vaginalis CBP confirmed/suspected; alternative STI regimens depend on diagnosis.
Side effects: Metallic taste, nausea, dark urine, neuropathy with prolonged use.
Interactions: Alcohol → disulfiram-like reaction; warfarin effect increases; avoid with disulfiram.
Bangladesh available brand examples: Flagyl 400 mg, Flamyd 400 mg, G-Metronidazole 400 mg, Metrol 400 mg, Metromax 400 mg.
9) Tamsulosin
Generic name: Tamsulosin hydrochloride
Therapeutic category: BPH/LUTS drug
Pharmacological class: Alpha-1A blocker
Why used: BPH/LUTS, prostatic congestion, voiding symptoms with hematospermia; bleeding directly stop করে না, urine flow improve করে।
Adult dose: 0.4 mg once daily after same meal, usually evening; duration depends on LUTS response.
Side effects: Dizziness, postural hypotension, abnormal ejaculation/retrograde ejaculation, nasal congestion.
Interactions: PDE-5 inhibitors sildenafil/tadalafil → hypotension; strong CYP3A4 inhibitors; other antihypertensives.
Bangladesh available brand examples: Prostanil MR 0.4 mg, Tamcontin 0.4 mg, Tamisol MR 0.4 mg, Tamlosin 0.4 mg, Urocap 0.4 mg, Sasolin MR 0.4 mg.
10) Finasteride / Dutasteride
Generic name: Finasteride 5 mg / Dutasteride 0.5 mg
Therapeutic category: BPH disease-modifying therapy
Pharmacological class: 5-alpha reductase inhibitor
Why used: Enlarged prostate/BPH-related recurrent bleeding or LUTS; prostate size reduce করে। Immediate hematospermia cure না; months লাগে।
Adult dose:
- Finasteride 5 mg once daily; assess after ≥6 months.
- Dutasteride 0.5 mg once daily.
Side effects: Decreased libido, erectile/ejaculatory dysfunction, breast tenderness, mood change rare; PSA about 50% কমিয়ে দিতে পারে—PSA interpretation adjust করতে হয়। NICE notes 5-ARI PSA levels reduce about 50% after 6 months.
Interactions: Dutasteride with strong CYP3A4 inhibitors; PSA interpretation issue.
Bangladesh available brand examples: - Finasteride: Pronor 5 mg, Prosfin 5 mg.
- Dutasteride: Dutamax 0.5 mg, Urodart 0.5 mg.
- Combination: Maxrin D 0.4+0.5 mg, Duodart 0.4+0.5 mg, Tamisol D 0.4+0.5 mg, Urocap-D 0.4+0.5 mg.
11) Tranexamic acid — routine না
Generic name: Tranexamic acid
Therapeutic category: Antifibrinolytic/hemostatic
Pharmacological class: Lysine analogue; plasminogen activation inhibitor
Why used: Hematospermia-তে routine নয়; only significant persistent bleeding, bleeding tendency, or specialist decision after malignancy/infection exclude.
Adult dose: Common adult hemostatic dose 500–1000 mg orally 2–3 times daily for short duration, but hematospermia-specific routine guideline dose নেই।
Side effects: Nausea, diarrhea, thromboembolic risk rare, visual disturbance rare.
Interactions: Combined hormonal therapy/thrombosis risk, anticoagulant strategy conflict, history of thrombosis caution.
Bangladesh available brand examples: Frabex 500 mg, Intrax 500 mg/650 CR, Tracid 500 mg/650 CR, Tranexil 500 mg, Hemostat 500 mg, Fibrino 500 mg.
10. Bangladesh doctors commonly prescribe — cause-based list
1. First episode, low risk:
No antibiotic. Reassurance ± NSAID short course if pain.
2. Painful ejaculation/pelvic discomfort without infection sign:
Ibuprofen 400 mg BD/TDS or Naproxen 250–500 mg BD for 3–5 days + review.
3. Urethral discharge/STI risk:
Ceftriaxone IM single dose + Doxycycline 100 mg BD 7–10 days depending syndrome; partner treatment and abstinence until both treated. CDC regimen supports ceftriaxone + doxycycline when chlamydia not excluded.
4. Prostatitis symptoms: fever, pelvic pain, tender prostate:
Urine culture first; severe/systemic illness হলে admission/IV antibiotic. Chronic bacterial prostatitis হলে ciprofloxacin/levofloxacin 4–6 weeks culture-guided per EAU.
5. Epididymitis/testicular pain:
Ceftriaxone + doxycycline if STI likely; levofloxacin if enteric organism only and gonorrhea ruled out. CDC regimen supports this approach.
6. BPH/LUTS with hematospermia:
Tamsulosin 0.4 mg daily; enlarged prostate হলে finasteride/dutasteride or combination.
7. Recurrent/persistent unexplained hematospermia:
Do not keep repeating antibiotics blindly. PSA/DRE, urine test, STI NAAT, TRUS/MRI/cystoscopy as indicated; urology referral.
11. Prevention — কীভাবে কমানো যায়
- Safe sex: condom, multiple/new partner হলে STI screening।
- STI partner management: patient + partner both treated না হলে reinfection হবে।
- Avoid vigorous intercourse/masturbation after bleeding episode for 1–2 weeks.
- Hydration + urinary infection early treatment।
- Blood pressure control। Severe hypertension bleeding tendency বাড়াতে পারে।
- Anticoagulant/antiplatelet review: নিজে বন্ধ করবেন না; prescriber-এর সাথে INR/bleeding risk review।
- BPH management: LUTS থাকলে early urology/medicine review।
- Age ≥40 screening mindset: recurrent hematospermia ignore করবেন না; DRE/PSA/urology referral।
- Avoid unnecessary antibiotics: culture/NAAT guided treatment antibiotic resistance কমায়।
- TB risk থাকলে evaluation: chronic urinary symptoms, sterile pyuria, weight loss/night sweat হলে GU-TB workup।
Overview / Summary
Hematospermia হলো semen-এ blood থাকা। Young low-risk patient-এ এটি বেশিরভাগ সময় benign ও self-limiting; কিন্তু age ≥40, recurrent/persistent episode, hematuria, fever, weight loss, bone pain, abnormal DRE/PSA থাকলে full urological evaluation দরকার। Treatment cause-based: reassurance, NSAID for pain, STI/prostatitis/epididymitis হলে guideline-based antibiotic, BPH/LUTS হলে tamsulosin ± 5-ARI, আর persistent case-এ TRUS/MRI/cystoscopy/urology referral।
Actionable Plan / Steps
- First visit: confirm true hematospermia; check age, recurrence, fever, hematuria, pain, STI risk, drug history.
- Exam: BP, temperature, genital/scrotal exam, DRE.
- Basic tests: urine R/M/E, urine culture, CBC, coagulation profile; STI risk হলে first-catch urine NAAT.
- Age ≥40 or recurrent: PSA after infection settles, DRE, urology referral.
- Treat cause: no blind antibiotic; use ceftriaxone/doxycycline/levofloxacin/ciprofloxacin only when syndrome and test support.
- Urgent referral: fever/sepsis, urinary retention, severe testicular pain, hematuria, abnormal prostate/testicular mass, persistent bleeding.
Reference List — Textbook + Guideline + DOI
Textbooks
- Campbell-Walsh-Wein Urology, 13th ed., Elsevier, 2025 — authoritative urology reference; incorporates AUA/EAU guidance in chapters.
- Harrison’s Principles of Internal Medicine, 22nd ed., McGraw Hill, 2025 — internal medicine/infectious disease/systemic bleeding context.
- Davidson’s Principles and Practice of Medicine, 24th ed., Elsevier, 2022 — adult medicine, infection/systemic disease approach.
Guidelines / clinical guidance
- Stefanovic KB, Gregg PC, Soung M. Evaluation and Treatment of Hematospermia. American Family Physician. 2009.
- RACGP. Haematospermia clinical approach. Australian Family Physician. 2015.
- CDC. Sexually Transmitted Infections Treatment Guidelines, 2021; gonorrhea and epididymitis regimens. DOI: 10.15585/mmwr.rr7004a1.
- EAU Guidelines on Urological Infections, current online guideline; bacterial prostatitis and epididymitis management.
Peer-reviewed journals with DOI
- Kumar P, Kapoor S, Nargund V. Haematospermia—A Systematic Review. Ann R Coll Surg Engl. 2006. DOI: 10.1308/003588406X114749.
- Liao LG, et al. Etiology of 305 cases of refractory hematospermia and therapeutic options by emerging endoscopic technology. Scientific Reports. 2019. DOI: 10.1038/s41598-019-41123-2.
- Wang R, Chen L, Bai X, Li T, Wu D, Chen J. Transrectal ultrasound-guided seminal vesicle catheterization with continuous antibiotic infusion for refractory hematospermia. Experimental and Therapeutic Medicine. 2021. DOI: 10.3892/etm.2020.9464.
Md.Rafiqul Islam Lipu,Date:-01-06-2026 Monday, Time:-06-48-37 Pm