title: Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia.
abstract: OBJECTIVE
  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 (=or>10(6) colony forming units [CFU]/mL) after three antibiotic courses. Fourteen infertile patients with initial chronic microbial (=or>10(6) CFU/mL) MAGI who responded to antibacterial treatment (<10(3) 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) 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-emphysematous 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Endocrinology, Andrology and Internal Medicine, Department of Biomedical Sciences, University of Catania, Garibaldi Hospital, 95123 Catania, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: La Vignera
authors.forename: Aldo E
authors.initials: AE
authors.lastname: Calogero
authors.forename: Alessandro
authors.initials: A
authors.lastname: Arancio
authors.forename: Roberto
authors.initials: R
authors.lastname: Castiglione
authors.forename: Gaetano
authors.initials: G
authors.lastname: De Grande
authors.forename: Enzo
authors.initials: E
authors.lastname: Vicari
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy; D004822:Epididymis / Q000000981:diagnostic imaging / Q000382:microbiology; D004823:Epididymitis / Q000150:complications / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007248:Infertility, Male / Q000000981:diagnostic imaging* / Q000382:microbiology*; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging / Q000382:microbiology; D011472:Prostatitis / Q000150:complications / Q000000981:diagnostic imaging*; D012007:Rectum / Q000000981:diagnostic imaging; D012669:Seminal Vesicles / Q000000981:diagnostic imaging / Q000382:microbiology; D014463:Ultrasonography / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents