AMBULATORY PRACTICE


ment by our service. These diagnoses are in con- trast to Sullins et al,1 who diagnosed 18 cases of hemospermia caused by urethral rent (n  1), ure- thritis (n  11), urethral varicosities (n  4), lym- phosarcoma (n  1), and unknown origin (n  1). Of those 18 cases, 15 were treated by subishcial urethrostomy. Of three treated with sexual rest, one died (lymphosarcoma) and two returned to breeding function.1 Of three stallions diagnosed with urethral rents, one returned to breeding func- tion after 11 months of sexual rest, one was cas- trated 6 weeks after urethrostomy when hemospermia recurred, and one resumed breeding function 10 weeks after urethrostomy.29 If surgical options are not elected to manage he- mospermia, whether caused by urethral rent or SCC, the practitioner must be prepared to manage affected horses medically. In our clinic, one stal- lion, for which subischial urethrostomy was repeat- edly declined, was treated medially by use of imipramine to lower the ejaculatory threshold be- fore semen collection. In two stallions, semen col- lection was attempted with minimal washing and teasing time to lower the risk of hemorrhage from erectile tissues. In six of the eight stallions (75%) presented here, semen collection was attempted ex copula. The one successful ejaculate was erythro- cyte-contaminated. Ex copula ejaculation allows for collection of concentrated semen without high corpus spongiousum pressures, although stallions with urethral rents may still bleed, as in Case 5. Although the technique was not successful in the majority of our cases, it is a technique that we per- form regularly in our clinic on debilitated stallions for genetic preservation. If hemospermia is unable to be managed medi-


cally, ejaculates can be manipulated to increase pregnancy rates. Semen from one stallion in our study was density-gradient centrifuged to obtain un- contaminated semen. It has been demonstrated that placing an extender in the uterus before live- cover mating may counteract some of the negative effects of erythrocytes on spermatozoa. Semen from stallions with seminal vesiculitis can be ex- tended with antibiotic-containing extender or place- ment of that extender in the mare.37 Collection of semen in fractions may help to improve fertility if only erythrocyte-free jets are processed for artificial insemination. The effects of hemospermia on fertility have been documented.27 The presence of blood in the ejacu- late has not been shown to affect spermatozoa mor- phology; however, in one study, the progressive motility and plasma membrane integrity were lower in semen with 10% or 20% added whole blood com- pared with unaffected ejaculates.39 It was noted in that study that spermatozoa appeared to accumu- late around the erythrocytes. In another study, se- men with 20% added whole blood resulted in a per- cycle pregnancy rate of 7.7%, whereas per-cycle pregnancy rates with the use of unaffected semen or


semen with 20% added serum were 28.6% and 50%, respectively.27 These studies demonstrate that the infertility observed in hemospermia cases are the result of the erythrocyte presence in the ejaculate and not the presence of serum, although the mech- anism whereby this infertility occurs is still un- known and warrants further investigation. Despite the medical and surgical techniques avail-


able to practitioners to manage stallions with hemo- spermia, no technique is 100% effective. To ensure acceptable fertility from breeding stallions, practi- tioners must educate stallion owners that collection and cryopreservation of semen from stallions when the horses are young and healthy is the best guar- antee against future financial losses caused by stal- lion debilitation or death, including hemospermia. In one of our cases, the horse was managed medi- cally for urethral rent during the breeding season, yet mares were still able to be bred through the use of previously frozen semen, preventing the farm from losing a foal crop.


6. Summary


Hemospermia can be devastating to a stallion’s fer- tility and welfare. The prognosis for recovery of breeding function and life are dependent on the di- agnosis. Practitioners who work with breeding stallions should educate stallion owners on the im- portance of routine breeding soundness examina- tions at the beginning of each breeding season and routine collection and semen cryopreservation of healthy stallions. These practices will help to iden- tify any pathology early, which can result in higher treatment success and survival rates, especially for SCC. Practitioners who diagnose hemospermia in breeding stallions but are unable to manage the horse should actively seek referral to a specialist.


Acknowledgments


No outside sources of funding were used in the com- pletion of this study. None of the authors declare any conflicts of interest, financial or otherwise, in relationship to this report.


References


1. Sullins K, Bertone J, Voss J, et al. Treatment of hemosper- mia in stallions: a discussion of 18 cases. Comp Cont Educ Pract 1988;10:1396–1403.


2. Freestone JF, Paccamonti DL, Eilts BE, et al. Seminal ve- siculitis as a cause of signs of colic in a stallion. JAmVet Med Assoc 1993;203:556–557.


3. Turner RMO. Urospermia and hemospermia. In: Samper JC, Pycock JF, McKinnon AO, editors. Current Therapy in Equine Reproduction. St Louis: Saunders; 2007:258–265.


4. Tibary A. Endoscopy of the reproductive tract in the stallion. In: Samper JC, Pycock J, McKinnon AO, editors. Current Therapy in Equine Reproduction. St Louis: Saunders; 2007: 214–219.


5. Pozor M, Macpherson M, Troedsson M, et al. Midline cysts of colliculus seminalis causing ejaculatory problems in stal- lions. J Equine Vet Sci 2011;31:722–731.


6. van den Top JGB, de Heer N, Klein WR, et al. Penile and preputial tumours in the horse: a retrospective study of 114 affected horses. Equine Vet J 2008;40:528–532.


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