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Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia

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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 elevated bacteriospermia (≥ 106 colony forming units [CFU]/mL) after three antibiotic courses. Fourteen infertile patients with initial chronic microbial (≥ 106CFU/mL) MAGI who responded to antibacterial treatment (< 103CFU/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) underwent both pre-ejaculatory 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-emphyse-matous prostate abscess); and (ii) prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts (group B: 15 cases, 22.4%). Mean sperm 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 from those 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.

Keywords: micro-emphysematous prostate abscess; persistent bacteriospermia; prostato-vesiculitis; sperm parameters; sub-obstruction of the ejaculatory ducts; ultrasound features

Document Type: Original Article


Affiliations: 1: Section of Endocrinology, Andrology and Internal Medicine, Department of Biomedical Sciences, University of Catania, 95123 Catania, Italy 2: Urology Unit, Ospedale Umber to I, 96100 Syracuse, Italy

Publication date: September 1, 2008


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