Objective: To assess the efficacy of transrectal ultrasonography (TRUS) in the evaluation of hematospermia. Material and Methods: This study included 54 patients with hematospermia. Patients age range was between 25 and 75 years (mean= 49.7 years). All patients were evaluated by TRUS using a biplane transducer and a Toshiba SSA-270A device. Results: TRUS revealed one or more abnormalities in 51 patients (94.5%). Prostatic calcifications were found in 23 patients, ejaculatory duct calculi in 21, dilated ejaculatory ducts in 18, benign prostatic hyperplasia in 18, dilated seminal vesicles in 12, calcifications in seminal vesicles in 11, ejaculatory duct cyst in 6, prostatitis in 6, and periurethral Cowper gland mass in 1. Conclusion: TRUS is a noninvasive, safe method for the investigation of causes of hematospermia. We believe that it should be the first radiological investigation to be performed in patients presenting with hematospermia. (C) 2004 Elsevier Inc. All rights reserved.