Hematospermia changed over months into chunks in ejaculate

[fort]

In the spring I experienced some urethral irritation - was seen by doctor and given one-dose zithromax and cipro and symptoms were gone.
Then in mid-June of this year I first experienced hematospermia in the form of caramel brown discolored ejaculate, no pain whatsoever.
I then checked on this every other day and was still there for a month at which time (mid-July) I saw the urologist in my city who ranks
highest on a quality survey (ranked by fellow MDs). He was not alarmed and did a DRE for about 2-3 seconds he felt the prostate, gave a PSA
(normal results on both). He looked at the urinalysis and said it was negative, the only thing was that there was a trace of blood in the urine
which he said could have been from the ejaculate being washed out by the urine. He told me to not be too concerned and to reschedule for mid October
(4 months after start of symptoms) to see if it had resolved itself.
I went for some acupuncture in late September early October as well as taking some natural remedies including things like saw palmetto. To my delight
the ejaculate finally changed back to its normal color in early October. In the first few instances of normal color it was normal color until the last
contraction of the ejaculation - the last contraction was slightly painful and produced  a last couple drops which were brownish. I then had one instance
of completely normal ejaculate. Since then, I have ejaculated about 3 more times and a new issue has come about.
The ejaculate is still normal color but a small amount of pain occurs during ejaculation and then either in the ejaculate or washed out in the urine directly
afterward are 2-4 tiny chunks of material each 1-2mm in size. They are a translucent amber color and are not rock hard nor are they extremely fragile. When they
passed in the post-ejaculation urination there was a tiny amount of pain in the urethra as each passed out.
My problem now is that I had such improvement in the discoloration of the ejaculate and now this new development has occurred. I rescheduled my follow-up with
the urologist for November, so I am following up with my personal physician as I know you recommend to do, however I would love a second opinion from you on this
- what could the chunks be and have you ever heard of such a thing? What could my problem me that caused hematospermia and now chunks and why would it change from
the hematospermia to the chunks?
I appreciate your help.

[Kevin Pho, MD]

Difficult to say without evaluation.  Cases of hematospermia can be attributed to infection or to the prostate.  There are a significant amount of causes that may not be found.  A negative DRE and PSA is encouraging.  

To complete the evaluation, you can consider a transrectal ultrasound to image the prostate.  This can evaluate for any masses or lumps that may be leading to the blood.  

Regarding the "chunks" of material - difficult to say what it is.  It is possible that they may be clots from the hematospermia.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

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