MP60-13 WHEN TO PERFORM SEMEN CULTURE IN ASYMPTOMATIC INFERTILE MEN? HINTS FROM A CROSS SECTIONAL STUDY

Abstract

You have accessJournal of UrologyInfertility: Basic Research & Pathophysiology1 Apr 2018MP60-13 WHEN TO PERFORM SEMEN CULTURE IN ASYMPTOMATIC INFERTILE MEN? HINTS FROM A CROSS SECTIONAL STUDY Eugenio Ventimiglia, Filippo Pederzoli, Paolo Capogrosso, Walter Cazzaniga, Nicola Frego, Francesco Chierigo, Edoardo Pozzi, Luca Boeri, Massimo Alfano, Federico Dehò, Emanuele Montanari, Franco Gaboardi, Vincenzo Mirone, Francesco Montorsi, and Andrea Salonia Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Filippo PederzoliFilippo Pederzoli More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Nicola FregoNicola Frego More articles by this author , Francesco ChierigoFrancesco Chierigo More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Luca BoeriLuca Boeri More articles by this author , Massimo AlfanoMassimo Alfano More articles by this author , Federico DehòFederico Dehò More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Franco GaboardiFranco Gaboardi More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1905AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The EAU guidelines suggest performing semen culture in case of increased leukocytes in semen. However, the clinical significance of an increased concentration of leukocytes in the ejaculate is controversial. Although leukocytospermia is a sign of inflammation, it is not necessarily associated with bacterial or viral infections. We aimed to retrospectively validate this recommendation in a cohort of Caucasian-European men seeking medical help for male factor couple's infertility. METHODS Complete socio-demographic, clinical and hormonal data from 547 consecutive infertile men seeking medical help for coupls's infertility and asymptomatic for genital infections were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs ≥2). Semen culture was obtained from every man after exclusion of urethritis and bladder infection. Polymerase chain reaction (PCR) DNA was used to identify Chlamydia trachomatis and Ureaplasma urealyticum in the semen. A concentration of >10ˆ3 cfu/mL urinary tract pathogens in the ejaculate was considered suggestive for significant bacteriospermia. Semen analysis values were assessed based on 2010 World Health Organization reference criteria. EAU guidelines for semen culture (leukocytospermia >106 WBCs/mL, according to WHO classification) were used to predict positive semen culture in our cohort and thus validated. Moreover, we tested the predictive performance and accuracy of several clinical parameters and compared them to EAU guidelines RESULTS Overall, a positive semen culture was found in 56 (10%) men. The most commonly identified pathogens belonged to the Enterobacteriaceae family (15% of all positive examinations). Of all, 141 (26%) patients had leukocytospermia >106 WBCs/mL and would have therefore deserved semen culture testing according to EAU guidelines; of them, 12 (9%) actually displayed a positive semen culture. Conversely, 44 (79%) out of 56 patients with positive semen culture would have been missed. Overall predictive accuracy, sensibility, and specificity of EAU guidelines were 48%, 21%, and 74% respectively. No further clinical parameter was significantly associated with positive sperm culture and could be therefore used as a predictor, except for increased serum neutrophil-to-lymphocyte (NRL) ratio (predictive accuracy 60%, p=0.03 vs. EAU guidelines). CONCLUSIONS The vast majority (79%) of asymptomatic infertile men with a positive sperm culture may miss a proper diagnostic assessment when relying on EAU guidelines. Of clinical importance, not a single parameter, except for NLR, can assist medical decision making. Therefore, a semen culture should be offered to every infertile man. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e794-e795 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Eugenio Ventimiglia More articles by this author Filippo Pederzoli More articles by this author Paolo Capogrosso More articles by this author Walter Cazzaniga More articles by this author Nicola Frego More articles by this author Francesco Chierigo More articles by this author Edoardo Pozzi More articles by this author Luca Boeri More articles by this author Massimo Alfano More articles by this author Federico Dehò More articles by this author Emanuele Montanari More articles by this author Franco Gaboardi More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...