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1999 Selected Abstracts from American Urological Association annual meeting

Chronic Pelvic Pain Syndrome (CPPS): Impact of Inflammation on Fertility Parameters and Seminal Plasma Markers

M Ludwig; A Vidal; I Schroeder-Printzen; W Pabst and W Weidner; Giessen, Germany (Presented by Dr. Ludwig)
Introduction and Objectives: The impact of defined urogenital inflammations on male fertility is still a matter of controversial debate. We analyzed fertility parameters and seminal plasma markers in patients with inflammatory and non-inflammatory CPPS (NIH IIIA/IIIB) with regard to signs of inflammation in prostatic secretions and/or ejaculate.
Methods: 112 consecutive patients (pts.) with a Giessen prostatitis symptom score 8 were included. All patients underwent "the four-glass test" including leukocyte determination in expressed prostatic secretions (EPS) and identical aliquots of first urine, midstream urine and urine after prostatic massage (VB3). Patients with 10 leukocytes in EPS (1000x) or 10 in VB3 (400x) were considered to be NIH IIIA. Patients with bacterial prostatitis were excluded. Spermiogramm analysis was done according to WHO and included pH, volume, total sperm count, sperm density, motility classes (Mika motion analyzer), morphology (Shorr stain), peroxidase positive leukocytes (PPL), vitality (eosin stain), elastase, -glutamyltransferase (-GT), fructose, and -glucosidase. Statistical analysis included Mann-Whitney U-test and Wilcoxon rank sum test.
Results: 48 patients demonstrated increased leukocytes in EPS or VB3 (inflammatory CPPS NIH IIIA), whereas 64 did not (non-inflammatory CPPS NIH IIIB). The ejaculate analysis of the two patient groups did not show significant differences in pH, total sperm count, sperm density, motility, morphology, vitality, fructose, and -glucosidase. The only significantly different findings were as follows:
NIH IIIA [mean ± SD]NIH IIIB [mean ± SD]p volume
2.75 ml ± 1.602.27 ml ± 1.910.05
1111.4 ng/ml ± 938.58213.8 ng/ml ± 408.50.001
PPL 2.03 mill/ml ± 4.71.16 mill/ml ± 0.480.001
-GT 4.27 U/ml ± 2.765.61 U/ml ± 2.570.001
Conclusions: Our data support previous results that elevated leukocyte counts in prostatic secretions or ejaculate as signs of inflammation have no impact on total sperm count, sperm density, motility, morphology, and vitality in patients with CPPS. Using ejaculate analysis, elevated elastase and decreased -GT may help to identify patients with inflammatory CPPS when the traditional leukocyte approach is inconclusive.
Source: 1999 AUA Meeting
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