Page 587 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

562 CHAPTER 2

VetBooks.ir HAEMOSPERMIA cover may originate from the mare, not the stal-
lion. Therefore, the mare should also be examined
Definition/overview
Haemospermia is the presence of blood in the semen carefully.
(Fig. 2.161). Diagnosis
Since several conditions can be responsible for hae-
Aetiology/pathophysiology mospermia, a thorough examination is imperative.
Blood in the semen may arise from wounds or lesions Collection via an artificial vagina and cytological
(habronemiasis or equine herpesvirus [EHV]) on the examination of the semen will confirm the presence
surface of the penis, ulcerations of the penile ure- of blood versus inflammatory cells, or both, in the
thra or urethral process, infections of the accessory ejaculate. In cases where haemorrhage is accompa-
glands, urethritis, urolithiasis, varicosities, orchitis/ nied by significant numbers of neutrophils, seminal
epididymitis or neoplasia. vesiculitis should be considered.
Examination should include inspection of the
Clinical presentation erect penis and urethral process for small ulcers,
Blood may be seen dripping from the end of the wounds or SCC lesions. The most common cause
penis or from the mare’s vulva following breeding. of a significant amount of fresh, bright red blood in
Alternatively, a red or brownish discolouration of the ejaculate is a urethral rent. Urethroscopy using
the semen following collection may be seen. Since a flexible fibreoptic endoscope can be performed
haemospermia is associated with reduced fertil- to identify urethral erosions or ulcerations, which
ity, the presenting complaint may include reduced are most commonly found at the level of the ischial
pregnancy rates. Haematuria may also be present if arch. Even small urethral lesions can lead to sig-
bleeding is due to a uretheral rent. nificant haemospermia due to the communication
between the lesion and the corpus spongiosum of
Differential diagnosis the penis.
Several conditions as noted above can cause
haemospermia. Blood observed following natural Management
Treatment depends on the source of the bleeding.
Most non-neoplastic surface lesions of the penis heal
2.161 uneventfully when stallions are provided with strict
sexual rest. Deeper lacerations of the penis may
require suturing. Infections of the accessory glands
are difficult to treat and carry a guarded prognosis
(see Seminal vesiculitis, p. 564).
Treatment of urethral rents involves strict sexual
rest of about 8–12 weeks. Many urethral ulcerations
fail to heal even with prolonged sexual rest and,
therefore, a temporary perineal subischial urethrot-
omy should be recommended to assist in healing by
preventing continued haemorrhage through the ure-
thral rent during urination. Systemic antibiotics and
a course of anti-inflammatories are useful adjunctive
therapies.

Prognosis
Fig. 2.161 Semen collected from a stallion with The prognosis is guarded depending on the source
haemospermia. A urethral laceration was identified by of bleeding and extent of the injury/infection.
urethroscopy.