The colour of semen is usually creamy white. If the colour changes noticeably with or without other genitourinary symptoms, it is timely to seek expert advice which may include semen analysis and culture.
The presentation is compatible with ureteric colic. XRay did not show the stone either because it was small, obscured by bowel content, radiolucent or passed. Further investigation is indicated to confirm or exclude the diagnosis. Above all, consulting the relevant specialist is mandatory to ensure that the affected kidney is not irreparably damaged and / or other more sinister condition is not the culprit.
The presentation, especially if the pain is bilateral in the presence of mild varicocele and doubtful torsion, can be due to conditions higher up in the urinary tract. While the offer of surgery is premature at this stage, further investigation of the relevant organs may unveil the culprit and shed light on the appropriate treatment.
Red blood cell in urine detected only by the microscope is called microscopic haematuria. As defined by the number, microscopic haematuria can further be classified as significant and otherwise. The shape of the red blood cell may reveal the origin; either glomerular or not. Stones in the genitourinary system can also cause microscopic or gross haematuria of non-glomerular in origin. Of course, double pathology resulting in microscopic haematuria consisting of two types of red blood cells may co-exist. Persistent microscopic haematuria, albeit insignificant to start with, need to be regularly monitored because it can be the earliest evidence of a progressive and deadly disease like neoplasm of the genitourinary system. Seeking advice from a urologist is the best option.
The symptom described is probably haemopermia; blood in semen. Though it is usually due to infection, other conditions including neoplasia of the prostate need to be considered. Recurrent episodes of haemospermia despite adequate management certainly warrant the attention of a urologist.
范健醫生(男)