Scrotal and transrectal ultrasound correlates of prostatitis-like symptoms in a cohort of infertility patients
F. Lotti, G. Corona, E. Filimberti, SDegli Innocenti, G. Forti & M. Maggi
Introduction: Prostatitis-like symptoms (PLS) may originate from the prostate or from pelvic or scrotal organs. The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) is considered the gold-standard instrument to assess PLS severity. Although several studies previously investigated the impact of prostatitis, vesiculitis or epididymitis on semen parameters, only a few studies evaluated the correlations between PLS and scrotal or transrectal colour-Doppler ultrasound (CDU) characteristics. We here evaluate these correlations, along with PLS and semen parameters possible associations, in infertile men.
Methods: PLS of 400 men complaining of couple infertility were assessed by NIH-CPSI. Index pain score ≥8 has been previously defined as indicative of moderate-severe symptoms. All patients underwent, during the same CDU session, seminal analysis and interleukin 8 (sIL8), a reliable surrogate marker of prostatitis, urino and seminal cultures, along with scrotal and transrectal CDU, before and after ejaculation.
Results: After adjusting for age, a positive association between NIH-CPSI total score and positive urino and/or seminal cultures, leukocytospermia and sIL8 levels was observed. Conversely, no correlation with semen parameters was found. Subjects with a higher NIH-CPSI total score more often had CDU features suggestive of inflammation of the prostate (including a higher arterial peak systolic velocity, APSV), seminal vesicles and epididymis. As assessed by ROC curve, at 10.4 cm/s APSV discriminates subjects with an index pain score ≥8 with a sensitivity and specificity of 76%. When subjects with an index pain score ≥8 were compared to the rest of the sample, a higher prevalence of prostate-vesicular and epididymal CDU abnormalities, positive cultures, leukocytospermia and higher sIL8 levels were observed, but no differences in semen parameters.
Conclusions: PLS are positively associated with positive cultures, leukocytospermia and sIL8 levels, along with prostate-vesicular and epididymal CDU abnormalities suggestive of inflammation. We suggest a 10.4 cm/s APSV cut-off to predict moderate-severe symptoms.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.