Prostatitis and infertility 2


Prostatitis and infertility
Page 2 of a 7 page collection of scientific abstracts on prostatitis and infertility
Abstracts on this page: Etiological factors \| MR imaging \| Vascular bed \| Oxygen radicals \| Prostatic cyst \| Ambiguous Questionnaire \| TRUS (Ultrasound) \| Clomiphene Citrate \| Enoxacin \| White Blood Cells in semen \| Wuzi Dihuang (Traditional Chinese Medicine) \| Chlamydia trachomatis \| Antibiotic and ejaculation treatments \| Page three of Infertility Abstracts \| Page four of Infertility Abstracts \| Page five of Infertility Abstracts \| Page six of Infertility Abstracts \| Page seven of Infertility Abstracts \|
NLM CIT. ID: 98013285 Relationship between etiological factors and total motile sperm count In 350 infertile patients. (back to top) Martin-Du Pan RC; Bischof P; Campana A; Morabia A, Department of Obstetrics and Gynecology University of Geneva, Switzerland. *Arch Androl 1997 Nov-Dec;39(3):197-210* The prevalence of different etiologic factors has been evaluated in 350 male patients consulting the same physician in an urban, ambulatory setting for primary or secondary infertility of more than 1 year. Environmental factors such as alcohol or drugs represented 12% of the etiologies, acquired diseases such as varicocele and prostatitis 40%, congenital diseases and primary testicular failure 16.2%, idiopathic cases 19.4%, and abnormality of sperm transport 7.4%. The severity of sperm alterations in the different etiologic categories was evaluated by the total motile sperm count per ejaculate (TMS) (normal > 16). The TMS was less than 5 in classical causes of male infertility such as testicular failure, endocrinopathy, cancer, or antisperm antibodies. It was more than 10 in controversial causes of infertility such as varicocele, prostatis, Chlamydial infections, and professional exposure to heat. After treatment, there was a nonsignificant increase of the TMS in the latter cases. In cases of azoospermia of pituitary origin, the TMS was normalized by a hormonal treatment. In some cases of azoospermia of possible obstructive origin, sperm appeared in the ejaculate after diclofenac treatment. The utility of andrological investigation and treatment is discussed. NLM CIT. ID: 97298253 MR imaging in male infertility. (back to top) Parsons RB; Fisher AM; Bar-Chama N; Mitty HA Department of Radiology Mount Sinai Medical Center, New York, NY *Radiographics 1997 May-Jun;17(3):627-37* In patients with male infertility, endorectal magnetic resonance (MR) imaging provides high-resolution images of the prostate gland and ejaculatory apparatus. The multiplanar capability of MR imaging allows production of a detailed map of the reproductive tract for guiding treatment. Causes of male infertility can be classified as congenital, acquired, infectious, or hormonal. Wolffian duct abnormalities include agenesis of the kidney, vas deferens, or seminal vesicle and cysts of the vas deferens, seminal vesicle, or urogenital sinus-ejaculatory duct. Mullerian duct abnormalities are less common and consist of mullerian duct cysts and utricle cysts. Cowper duct cysts and peripheral-zone prostatic cysts are acquired causes of male infertility. Prostatitis, an infectious cause of male infertility, may mimic carcinoma on long repetition time/echo time images. A low testosterone levels is one of the hormonal causes of male infertility. Pitfalls in the interpretation of MR images can be avoided by familiarity with normal and abnormal findings in patients with male infertility. NLM CIT. ID: 97239992 The interrelationship of changes in the vascular bed of the testes to the status of the spermogram in the pathogenesis of infertility (back to top) *Lik Sprava 1996 Oct-Dec;(10-12):132-5* Infertile marriage is a burning medical and social problem. In spite of this the pathogenesis of infertility in men is not at present fully understood. The present investigation was designed to study general regularities of interrelation between changes in vascular bed of the testis and state of spermogramme in the pathogenesis of infertility. As many as 156 infertile patients were enrolled into the study, 420 rats Wistar used. Infertility resulted from varicocele, cryptorchism, epididymitis, prostatitis, obstruction of the deferent duct as well as from effects of electromagnetic field. It has been ascertained that progression of structural disorders of the intraorganic and haemomicrocirculatory bed of the testis is directly related to worsening of spermogramme indicators. NLM CIT. ID: 96288036 A possible therapeutic improvement of the antibacterial effect by monitoring the production of leukocyte free oxygen radicals during antibiotic treatment of infertile patients with chronic bacterial prostatitis (back to top) *Arch Ital Urol Androl 1996 Apr;68(2):91-7* In the male chronic accessory gland bacterial infections (AGBI), antibiotic treatment (AT) efficacy usually evaluates the antimicrobial outcome through one or more spermiocolture (SC) become negative. Recently, bacterial olipeptide fmpl has been used to detect a specific Radical Oxygen Species production by leukocytes (L-RLO), even when they are present at low concentrations in sperm fractions specimens. In the male AGBI could be present endogenous fmlp at sufficient levels to produce L chemiotaxis in the semen, and secondly active their specific L-RLO production, till when bacteriospermia remained positive. In the Percoll 50% (Pc50%) fraction, at higher L concentrations, from 22 infertile patients affected by chronic bacterial prostatitis (BP) and enrolled to a randomly AT treatment with a Quinolone (n = 12) or a Macrolide (n = 10), through two secondary milestones (possible elevated basal L-RLO in the pre-treatment, T0; significant changes in the basal and fmlp-stimulated L-RLO production within each treatment group and between groups), we would verify if a normalized L-RLO production could be taken as break-point for the AT withdrawal before checking SC for control. Indeed, in T0 all patients had positive SC and exhibited both basal and fmlp-stimulated L-RLO levels higher than those observed in 2 control groups (group ca = 10 fertile men, without chronic BP; group cb = 10 patients affected by chronic abacterial prostatitis (AP). On the 3rd AT cycle for 14 days, together in 20/22 AT-treated patients, basal and fmlp-stimulated L-RLO levels become low or normal, as well as their scs become negative (CFU/ml = 0), whilst in a third control group (group cc) of 10 not-AT-treated BP patients, through matched-follow-up observations, these L-RLO values were always elevated and their SC remained positive (CFU/ml > or = 10(5)). In chronic BP patients, AT seems to demonstrate both antimicrobial effectiveness and reduction of L-RLO production with values similar to those of control group ca. The monitored L-RLO values during AT could be useful in order to optimize antimicrobial effect: this tool being able to previse SC outcome, could be assumed to define clearly AT break-point and/or cycle numbers. NLM CIT. ID: 96230162 Transurethral marsupialization of a medial prostatic cyst in patients with prostatitis-like symptoms (back to top) Dik P; Lock TM; Schrier BP; Boon TA Department of Urology Central Military Hospital and University Hospital Urecht, The Netherlands *J Urol 1996 Apr;155(4):1301-4* Purpose: The results of transurethral marsupialization as treatment for medial prostatic cysts were assessed. Materials and Methods: between June 1992 and August 1994 we performed transrectal ultrasound on 704 patients with symptoms of bladder outlet obstruction or lower urinary tract symptoms and a medical prostatic cyst was found in 34 (5%). Transurethral marsupialization of the cyst via incision of the prostatic floor under transrectal ultrasound guidance was performed in 18 patients. Followup was 12 to 25 months (mean 18). Results: Patients with a medial prostatic cyst complained of prostatitis-like symptoms (77%), scrotal pain (62%), impaired micturition (32%), small volume ejaculation (35%), painful ejaculation (24%), hemospermia (24%) and infertility (12%). After marsupialization of the cyst, symptoms resolved completely in 14 patients (78%), improved in 17 (94%) and did not improve in only 1 (6%). No complications of this procedure were noted. The 16 patients who did not undergo surgery still complain of prostatitis-like symptoms without evidence of bacterial prostatitis. Conclusions: We believe that a medial prostatic cyst can cause prostatitis-like symptoms and that marsupialization of the cyst can provide symptom relief in the majority of patients. NLM CIT. 96245926 The symptom questionnaire for benign prostatic hyperplasia: an ambiguous indicator for an ambiguous disease (back to top) Stoevelaar HJ; van de Beek C; Nijs HG; Casparie AF Mcdonnell J; Janknegt RA Institute for Health Policy and Management Erasmus University Rotterdam, The Netherlands. *Br J Urol 1996 Feb;77(2):181-5* Objective: To assess the criterion validity of the American Urological Association (AUA) symptom index for benign prostatic hyperplasia (BPH) in urological practice. Patients and Methods: The study comprised 1414 consecutive men > or = 50 years of age, newly referred to a urologist in a stratified sample of 12 hospitals throughout the Netherlands, who completed the AUA symptom questionnaire at their first visit. The 39 urologists completed a questionnaire on the diagnosis. The discriminative power of the index for BPH versus other urological diagnoses was calculated by receiver operating characteristic (ROC) analysis. Subsequently, criterion sensibility was studied by assessing the effect of particular variables on the probability of the diagnosis of BPH. Results: ROC areas were low for BPH versus prostate cancer (0.57, SE 0.04), chronic prostatitis/prostatodynia (0.65, SE 0.03), and other diseases of the lower urinary tract (0.57, SE 0.04). Satisfactory to good values were found for BPH versus diseases of the upper urinary tract (0.79, SE 0.03), impotence/infertility (0.79, SE 0.04), penile- scrotal diseases (0.85, SE 0.02), and no abnormalities (0.84, SE 0.03). The diagnosis of BPH, as made by urologists in daily practice, appeared to be a weak criterion. Irrespective of other characteristics, the chance of being diagnosed with BPH was affected by differences in definition and the type of hospital. Conclusion Although the AUA index discriminated fairly well between BPH and diseases of the upper urinary tract, as well as genital diseases, it has no potential for distinguishing BPH from other diseases of the lower urinary tract. In addition, the lack of consensus in defining clinical BPH underscores the weakness of the index as a tool in the diagnostic process of this disease. "NLM CIT. 96113244 Transrectal ultrasound in male infertility (back to top) Li MK; Tan HH , Department of Urology Singapore General Hospital Singapore. *Ann Acad Med Singapore 1995 Jul;24(4):566-8* In the evaluation of the subfertile man who has severe oligospermia or azoospermia associated with a low volume ejaculate, the high resolution transrectal ultrasound (TRUS) has, in recent years, been a very important non-invasive imaging technique to detect abnormalities in the seminal vesicles, ejaculatory duct and the status of the prostate. We performed TRUS in 30 of these patients from January to December 1994 followed by scrotal exploration with vasogram using methylene blue, inspection of the epdidymis for dilatation and fibrosis together with testicular biopsy to evaluate testicular spermatogenesis and obstruction. Of the 30 patients, 11 were found to have dilated vesicles or ejaculatory duct obstruction. Three had features of prostatitis with calcification or thickened wall of the vesicles and one had an absent vesicle and vas. The remaining 15 patients had normal seminal vesicles and ejaculatory ducts on TRUS and their testicular biopsies showed atrophy, fibrosis or maturation arrest. Transurethral resection of the ejaculatory duct (TRU-ED) under TRUS guidance was done for 10 patients with dilated seminal vesicles and 6 of them had normal semen analysis 3 months after operation. Two successful pregnancies were achieved. NLM CIT. 96055326 Nonbacterial pyospermia: a consequence of clomiphene citrate therapy (back to top) Matthews GJ; Goldstein M; Henry JM; Schlegel PN, James Buchanan Brady Foundation Department of Urology New York Hospital-Cornell University Medical Center New York, USA Int J Fertil Menopausal Stud 1995 Jul-Aug;40(4):187-91 Objective: Since the development of nonbacterial pyospermia in previously nonpyospermic men treated with clomiphene citrate (CC) has been observed, and nonbacterial prostatitis has been after antiestrogen treatment in an animal model, we sought characterize the occurrence of nonbacterial pyospermia in men treated with CC. Patients and Methods: Forty-two nonpyospermic men with low serum testosterone levels treated with 25 mg CC/day were retrospectively compared to 27 untreated nonpyospermic men referred for infertility evaluation. Results: Spontaneous nonbacterial pyospermia developed in CC-treated men [14.3%] at rate nearly twice that observed in controls [7.4%]. Serum testosterone increased in CC-treated men, both pyospermic and nonpyospermic. However, only CC-treated, nonpyospermic men demonstrated improvement in semen characteristics. CC-treated men who developed pyospermia were older than nonpyospermic men [pyospermic, 41.7 +/- 8.1 years; nonpyospermic, 35.6 +/- 4.9 years-P < .01). Men over 35 years of age were over six times as likely to develop pyospermia as men under 35 years of age (P < .05). Eight nonpyospermic, CC-treated men (8/36, 22.2%) have contributed to pregnancies leading to live births, whereas no pyospermic man has done so. Conclusion: These findings support an association between a nonbacterial inflammatory response of the human male reproductive tract and CC treatment. This pyospermia may occur without significant deterioration of semen characteristics and with an appropriate response to treatment in terms of serum testosterone level. Men over the age of 35 are statistically more likely to develop pyospermia with this therapy. Our results suggest that clomiphene citrate-associated pyospermia has a negative effect on male fertility. NLM CIT. 95396721 Efficacy of enoxacin in the treatment of prostatitis-vesiculitis: its absence of toxicity on spermatogenesis (back to top) Barletta D; Monzani F; Gasperi M; Caraccio N Maccanti O; Bellitti P; Bonadio M; Pucci E, Clinique medicale I Universite de Pise Italie Presse Med 1995 Jun 17;24(22):1025-7 Objectives: The ability of enoxacin, a second generation quinolone, to diffuse into the seminal fluid both of normal volunteers (n = 10, protocol A) and patients with prostato-vesiculitis and positive sperm cultures (n = 10, protocol B) was investigated. In addition, the microbiological effectiveness and the occurrence of adverse effects on spermatogenesis were evaluated in the patient group. Methods: Enoxacin was administered in oral doses of 300 mg b.i.d. For two and seven days to volunteers and patients, respectively. Two hours after the last drug administration, blood, semen and urine samples were collected to determine seminal fluid antibiotic concentrations by microbiological agar diffusion assay. In protocol B, sperm cultures and sperm analyses were performed at the end of treatment and repeated at 30 and 90 days follow-ups. Results: In both protocols significant seminal fluid antibiotic concentration was achieved, thus providing evidence for considerable diffusion of the drug into prostate gland and seminal vesicles. Moreover, sperm cultures were sterile in all patients, and semen analysis demonstrated that spermatogenesis was not impaired by antibiotic treatment; on the contrary, 30 days after drug withdrawal percentage sperm motility improved, and the rate of abnormal forms decreased. Conclusions: The absence of adverse effects, both general and specifically on spermatogenesis, may be related to the restriction of indications and the brevity of the therapeutic cycles. Our results suggest that enoxacin may be successfully and safely used, in short term courses, for the treatment of documented genital tract infection by sensitive organisms. Further studies are needed to thoroughly evaluate the potential adverse effects on fertility of this quinolone, particularly when used for long-term suppressive therapy in patients with chronic urological infections. NLM CIT. ID: 95269811 The biologic significance of white blood cells in semen (back to top) Wolff H Department of Dermatology Ludwig-Maximilians-University Munich, Germany *Fertil Steril 1995 Jun;63(6):1143-57* Objective: To analyze the data available on the biologic significance of white blood cells (WBC) in semen of infertility patients. Data Resources: The relevant literature was reviewed. Results: It is not possible to identify reliably WBC by conventional sperm staining techniques. The peroxidase method is sufficient for quantification of granulocytes, but immunocytology is the gold standard for the detection of all WBC populations in semen. Granulocytes are the most prevalent WBC type in semen (50% to 60%), followed by macrophages (20% to 30%) and T-lymphocytes (2% to 5%). The prevalence of leukocytospermia (> 10(6) WBC/ml semen) among male infertility patients is approximately 10% to 20%. There is controversy on the significance of WBC in semen. Whereas some authors did not observe sperm damage in the presence of leukocytospermia, others have found evidence that WBC are significant cofactors of male infertility: [1] seminal WBC numbers were higher in infertility patients than among fertile men; [2] leukocytospermia was associated with decreased sperm numbers and impaired sperm motility; [3] WBC damaged sperm function and hamster ovum penetration in vitro and were important prognostic factors for IVF-ET failure. Because of absence of clinical symptoms, the origin of WBC is difficult to determine. Normally, most WBC appear to originate from the epididymis because vasectomized men show very few WBC in semen. On the other hand, leukocytospermic samples show low citric acid levels, pointing to asymptomatic prostatitis as a source of WBC in semen. Surprisingly, approximately 80% of leukocytospermic samples are microbiologically negative. In some cases Chlamydia trachomatis might have triggered a persistent inflammatory reaction leading to leukocytospermia. Sperm damage by WBC can be mediated by reactive oxygen species, proteases and cytokines. Furthermore, genital tract inflammation facilitates the formation of sperm antibodies. As seminal plasma has strong anti- inflammatory properties and because there is only short contact between sperm and WBC in prostatitis and seminal vesiculitis, inflammations of the epididymis and testis are likely to have the largest impact on sperm. Conclusions: There is ample evidence that WBC can affect sperm function. Further studies are needed to define cofactors that increase or decrease the risk of sperm damage by WBC. NLM CIT. 95375516 Clinical and experimental study on composite wuzi dihuang liquor in treating male infertility (back to top) Yang XF; Wei T; Tong J Taiyuan Central Hospital *Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1995 Apr;15(4):209-12* Composite Wuzi Dihuang Liquor (CWDL) in treating male infertility was used. The results showed that the effective rate was 84%. CWDL is indicated in mild and medium idiopathic oligozoospermia. There was some effect in the male infertility which was complicated by prostatitis, varicocele, antisperm antibody positive patients, but was ineffective in severe oligozoospermia, azoospermia, tesicular Volume 15ml, endocrinologic and chromatic abnormality. Experimental study revealed that the drug could significantly increase the percentage of reproductivity in mice and could directly safeguard the sperm of male infertility patients. NLM CIT. ID: 95223673 Detection of Chlamydia trachomatis in chronic prostatitis by in situ Hybridization (preliminary methodical report) (back to top) Kadar A; Bucsek M; Kardos M; Corradi G, Pathologiai Intezet Semmelweis Orvostudomanyi Egyetem Budapest, Hungary *Orv Hetil 1995 Mar 26;136(13):659-62* (Preliminary methodical report). In situ hybridization of Chlamydia trachomatis in formalin fixed, paraffin embedded specimens from the Urology Clinic were performed in 2nd Department of Pathology Semmelweis University of Medicine by a biotin labelled DNA probe. Chlamydia trachomatis is suspected to be responsible for the chronic abacterial inflammation of the prostate besides Ureaplasma urealyticum and Mycoplasmae. According to our retrospective study out of 79 biopsy specimens 34 had the diagnosis of chronic abacterial prostatitis. We examined 11 specimens of them. Bacteria were not identified. Three specimens were positive for Chlamydia trachomatis which were improved by transmission electron microscope. The age of patients was between 59 and 81 years. The detection of chlamydia infection rises the suspicion of a "healthy" career and especially at younger age could cause Chlamydia trachomatis associated genital disease. The undiagnosed and untreated diseases may lead to infertility. NLM CIT. ID: 95388125 Antibiotic and ejaculation treatments improve resolution rate of leukocytospermia in infertile men with prostatitis (back to top) Yamamoto M; Hibi H; Katsuno S; Miyake K Department of Urology Nagoya University School of Medicine Nagoya, Japan *Nagoya J Med Sci 1995 Mar;58(1-2):41-5* Leukocytospermia has been associated with notable adverse effects on semen parameters and sperm function. The present study was undertaken to identify men with leukocytospermia and prostatitis in an infertility population and assess the effects of various treatments. One million white blood cells (WBC)/ml semen was defined as leukocytospermia. An expressed prostatic fluid was analyzed for the presence of white blood cells. The presence of more than 10 wbcs/high power field on expressed prostatic secretion was needed for the diagnosis of prostatitis. Those men who had more than one million WBC s in their semen and more than 10 WBC s/high power field on expressed prostatic secretion were enrolled in this study. Of two hundred sixty-three men screened for the presence of leukocytospermia and prostatitis, forty-eight men met both criteria. They were blindly and randomly assigned to one of three groups. Group 1 received no treatment. Group 2 were treated with trimethoprim 80 mg- sulfamethoxazole 400 mg (TMP-SMX) orally twice per day for one month. Group 3 were treated not only with the same antibiotic regimen as group 2 but also were instructed to ejaculate frequently (at least once every three days) for one month. Significant resolution of leukocytospermia occurred in the order of patient groups 3 > 2 > 1 at one month. The resolution rate of leukocytospermia of each group was 76% in group 3, 56% in group 2 and 6.7% in group 1. The rates in groups 2 and 3 were significantly higher than that in group 1 (p < 0.05).

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