Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia.
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.
La Vignera
Sandro
S
Section of Endocrinology, Andrology and Internal Medicine, Department of Biomedical Sciences, University of Catania, Garibaldi Hospital, 95123 Catania, Italy.
Calogero
Aldo E
AE
Arancio
Alessandro
A
Castiglione
Roberto
R
De Grande
Gaetano
G
Vicari
Enzo
E
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*
D000900:Anti-Bacterial Agents