Hematospermia is a common, but anxiety-provoking genitourinary condition. In instances without spontaneous resolution, pharmacologic intervention with a 5-alpha reductase inhibitor has been shown to be successful. In cases of refractory hematospermia, robotic-assisted laparoscopic seminal vesiculectomy may provide a definitive treatment option. A robotic-assisted bilateral seminal vesiculectomy was performed on a 42-year-old male with refractory painless hematospermia after failing conservative management. Three months post-operatively, the patient reported resolution of hematospermia after six ejaculations with no impact on erectile function. The robotic-assisted approach is safe and feasible with good functional outcomes and reduced morbidity. •Hematospermia can be caused by a variety of genitourinary conditions.•5-alpha reductase inhibitors may be used to treat refractory hematospermia.•5-alpha reductase inhibitors may not be tolerated due to sexual side effects.•Robotic seminal vesiculectomy successfully treats refractory hematospermia.