Prostatitis and hematuria

[Arnon Krongrad, MD]

A 57-year old man presented with a CPSI score of 36. He reported a 30-year history of low back pain, flu-like symptoms, suprapubic pain, perineal pain, and a sensation of "sitting on a golf ball."His only physical sign was intermittent gross hematuria, associated with symptomatic flareup.

 

Over the years, he had tried and failed to get relief from antibiotics, alpha blockers, supplements, massage, heating pads, sitz baths, prostate injections, and prostate microwave. He then had laparoscopic prostatectomy, immediately after which he reported complete symptom resolution.

 

Below are his intra-operative images, which show one unusual finding at the right vas deferens (arrow).

 

What is this unusual finding?

[G8 GT]

Is that a tumor?  Cyst?

[Arnon Krongrad, MD]

The color is dark brown, like chocolate. The consistency is that of thick liquid, like chocolate syrup.

 

What is thick, dark, brown liquid and can be found by the vas deferens?

[G8 GT]

I may be wrong, but the sperm travel via the vas deferens from the epididymis, up to the seminal vesicles, which produce a rather thick liquid.   The sperm mixes at that point with this liquid, along with fluids from the prostate gland as well as bulbourethral glands.  The thing I cannot figure out, however, is the brownish color.  Could that be blood from trauma or infection?  Did the patient have a vasectomy in the past?

[Arnon Krongrad, MD]

No history of vasectomy.

[G8 GT]

I really have no idea then.  It would seem to be something related to bleeding, but what would be the clotting factor in that area? 

 

[Arnon Krongrad, MD]

It was not clotted. Rather, it was liquid and easily aspirated.

[Arnon Krongrad, MD]

Patient is more than 5 months post-op. He reports that the prostatitis pain is gone and has stayed gone. FYI.

[G8 GT]

Awesome news!  But I have to ask, what was that liquid?

[Dave]

I remember reading a urological surgeon talking about their experience of many 'prostatitis' patients suffering from blocked ejaculatory ducts from the seminal vesicles into the urethra and, that when he "sorted" them (my technical term, as I forget how), then all too often there would be an oozing of brown fluid and immediate relief of much of the discomfort. Sounds related?

 

Anyway, presumably it was red blood cells as you mention hematuria, which presumably had been diagnosed by analysis? - if that is the case then was this something coming out of the SVs into the urine, or was it urine refluxing back up the ejaculatory ducts? Or something else altogether?

 

[Arnon Krongrad, MD]

G8 GT, we didn't sent it to the lab, but it had to be old blood.

Dave, brown fluid in the urethra could in theory be blood, sure. Do you have the reference?

[Dave]

No, unfortunately I was just casual browsing and didn't save it.