Transrectal Ultrasonography In Infertile Patients With Persistently Elevated Bacteriospermia

Asian J Androl 2008; 10 (5): 731–740

DOI: 10.1111/j.1745-7262.2008.00425.x

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Original Article .

Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia
Sandro La Vignera1, Aldo E. Calogero1, Alessandro Arancio1, Roberto Castiglione1, Gaetano De Grande2, Enzo Vicari1
Section of Endocrinology, Andrology and Internal Medicine, Department ofBiomedical Sciences, University of Catania, 95123 Catania, Italy 2 Urology Unit, Ospedale Umberto I, 96100 Syracuse, Italy
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Abstract Aim: To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection (MAGI) who failed to respond to antibacterial treatment. Methods: We selected 67 consecutive patients with MAGI and persistently elevatedbacteriospermia (≥ 106 colony forming units [CFU]/mL) after three antibiotic courses. Fourteen infertile patients with initial chronic microbial (≥ 106 CFU/mL) MAGI who responded to antibacterial treatment (< 103 CFU/mL) served as a control group. All patients and controls underwent transrectal ultrasonography (TRUS) scans and semen analysis. Patients with low seminal plasma volume (< 1.5 mL) underwentboth preejaculatory and post-ejaculatory TRUS examination. Results: TRUS revealed multiple abnormalities indicative of: (i) bilaterally extended prostato-vesiculitis (group A: 52 cases, 77.6%) (nine of these patients also had micro-emphysematous prostate abscess); and (ii) prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts (group B: 15 cases, 22.4%). Meansperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different fromthose of controls. Conclusion: Although antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria (clinical history, physical and ejaculate signs). Thus, TRUS may be helpful in the follow-up of these patients. (Asian J Androl 2008 Sep; 10: 731–740)
Keywords: persistentbacteriospermia; prostato-vesiculitis; sub-obstruction of the ejaculatory ducts; micro-emphysematous prostate abscess; sperm parameters; ultrasound features

Correspondence to: Prof. Enzo Vicari, Department of Biomedical Sciences, University of Catania, Garibaldi Hospital, 95123 Catania, Italy. Tel: +39-95-759-4005 Fax: +39-95-310-899 E-mail: acaloger@unict.it Received 2008-01-08 Accepted2008-05-25
Tel: +86-21-5492-2824;Andrology, SIMM and SJTU. All rights reserved. © 2008, Asian Journal of Fax: +86-21-5492-2825; Shanghai, China

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Introduction

Prostatitis is a common urological condition that many physicians find difficult to treat effectively. Acute bacterial prostatitis (category I, National Institute of Health

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Ultrasound abnormalities and persistentbacteriospermia

[NIH] classification) has an abrupt onset characterized by fever, genitourinary and general signs and symptoms. The microbiological diagnosis of acute bacterial prostatitis is straightforward and easily accomplished. However, the microbiological diagnosis of chronic bacterial prostatitis (category II, NIH classification) is particularly challenging in an andrological setting, especially ininfertile patients without symptoms (category IV, NIH classification) and with male accessory gland infection (MAGI) [1]. The occasional detection of bacteria in significant concentrations (> 10 5 colony forming units [CFU]/mL) in the semen specimen of these patients is followed by one or more courses of antibacterial therapy judged by bacteriological results and clinical symptoms [2, 3]. However,...