Semen analysis in chronic bacterial prostatitis: Diagnostic and therapeutic implications

Vittorio Magri, Florian M E Wagenlehner, Emanuele Montanari, Emanuela Marras, Viviana Orlandi, Antonella Restelli, Erminio Torresani, Kurt G. Naber, Gianpaolo Perletti

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the 'two-glass' pre-/post- massage test and the standard 'four-glass' test with a 'five-glass' test (four-glass plus post-VB3 semen culture). The 'five-glass' test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions (-13.2% or -14.7%) in relative specificity for traditional uropathogens (TUs) compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden's index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the 'five-glass' assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs (Enterobacteriaceae, Enterococci, etc.) in 120, 33, and 20 patients and unusual pathogens (Streptococci, other Gram-positive species, Mycoplasmata, and others) in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup of prostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.

Original languageEnglish
Pages (from-to)461-477
Number of pages17
JournalAsian Journal of Andrology
Volume11
Issue number4
DOIs
Publication statusPublished - 2009

Fingerprint

Prostatitis
Semen Analysis
Glass
Therapeutics
Semen
Signs and Symptoms
Databases
Massage
Fluoroquinolones
Macrolides
Enterococcus
Enterobacteriaceae
Streptococcus
ROC Curve
Area Under Curve
Pharmacology

ASJC Scopus subject areas

  • Urology

Cite this

Magri, V., Wagenlehner, F. M. E., Montanari, E., Marras, E., Orlandi, V., Restelli, A., ... Perletti, G. (2009). Semen analysis in chronic bacterial prostatitis: Diagnostic and therapeutic implications. Asian Journal of Andrology, 11(4), 461-477. https://doi.org/10.1038/aja.2009.5

Semen analysis in chronic bacterial prostatitis : Diagnostic and therapeutic implications. / Magri, Vittorio; Wagenlehner, Florian M E; Montanari, Emanuele; Marras, Emanuela; Orlandi, Viviana; Restelli, Antonella; Torresani, Erminio; Naber, Kurt G.; Perletti, Gianpaolo.

In: Asian Journal of Andrology, Vol. 11, No. 4, 2009, p. 461-477.

Research output: Contribution to journalArticle

Magri, V, Wagenlehner, FME, Montanari, E, Marras, E, Orlandi, V, Restelli, A, Torresani, E, Naber, KG & Perletti, G 2009, 'Semen analysis in chronic bacterial prostatitis: Diagnostic and therapeutic implications', Asian Journal of Andrology, vol. 11, no. 4, pp. 461-477. https://doi.org/10.1038/aja.2009.5
Magri V, Wagenlehner FME, Montanari E, Marras E, Orlandi V, Restelli A et al. Semen analysis in chronic bacterial prostatitis: Diagnostic and therapeutic implications. Asian Journal of Andrology. 2009;11(4):461-477. https://doi.org/10.1038/aja.2009.5
Magri, Vittorio ; Wagenlehner, Florian M E ; Montanari, Emanuele ; Marras, Emanuela ; Orlandi, Viviana ; Restelli, Antonella ; Torresani, Erminio ; Naber, Kurt G. ; Perletti, Gianpaolo. / Semen analysis in chronic bacterial prostatitis : Diagnostic and therapeutic implications. In: Asian Journal of Andrology. 2009 ; Vol. 11, No. 4. pp. 461-477.
@article{cb9bc772118c4550a99fb0ae0045dcec,
title = "Semen analysis in chronic bacterial prostatitis: Diagnostic and therapeutic implications",
abstract = "The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the 'two-glass' pre-/post- massage test and the standard 'four-glass' test with a 'five-glass' test (four-glass plus post-VB3 semen culture). The 'five-glass' test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions (-13.2{\%} or -14.7{\%}) in relative specificity for traditional uropathogens (TUs) compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden's index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the 'five-glass' assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs (Enterobacteriaceae, Enterococci, etc.) in 120, 33, and 20 patients and unusual pathogens (Streptococci, other Gram-positive species, Mycoplasmata, and others) in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup of prostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.",
author = "Vittorio Magri and Wagenlehner, {Florian M E} and Emanuele Montanari and Emanuela Marras and Viviana Orlandi and Antonella Restelli and Erminio Torresani and Naber, {Kurt G.} and Gianpaolo Perletti",
year = "2009",
doi = "10.1038/aja.2009.5",
language = "English",
volume = "11",
pages = "461--477",
journal = "Asian Journal of Andrology",
issn = "1008-682X",
publisher = "Nature Publishing Group",
number = "4",

}

TY - JOUR

T1 - Semen analysis in chronic bacterial prostatitis

T2 - Diagnostic and therapeutic implications

AU - Magri, Vittorio

AU - Wagenlehner, Florian M E

AU - Montanari, Emanuele

AU - Marras, Emanuela

AU - Orlandi, Viviana

AU - Restelli, Antonella

AU - Torresani, Erminio

AU - Naber, Kurt G.

AU - Perletti, Gianpaolo

PY - 2009

Y1 - 2009

N2 - The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the 'two-glass' pre-/post- massage test and the standard 'four-glass' test with a 'five-glass' test (four-glass plus post-VB3 semen culture). The 'five-glass' test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions (-13.2% or -14.7%) in relative specificity for traditional uropathogens (TUs) compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden's index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the 'five-glass' assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs (Enterobacteriaceae, Enterococci, etc.) in 120, 33, and 20 patients and unusual pathogens (Streptococci, other Gram-positive species, Mycoplasmata, and others) in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup of prostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.

AB - The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the 'two-glass' pre-/post- massage test and the standard 'four-glass' test with a 'five-glass' test (four-glass plus post-VB3 semen culture). The 'five-glass' test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions (-13.2% or -14.7%) in relative specificity for traditional uropathogens (TUs) compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden's index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the 'five-glass' assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs (Enterobacteriaceae, Enterococci, etc.) in 120, 33, and 20 patients and unusual pathogens (Streptococci, other Gram-positive species, Mycoplasmata, and others) in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup of prostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.

UR - http://www.scopus.com/inward/record.url?scp=69749095736&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=69749095736&partnerID=8YFLogxK

U2 - 10.1038/aja.2009.5

DO - 10.1038/aja.2009.5

M3 - Article

C2 - 19377490

AN - SCOPUS:69749095736

VL - 11

SP - 461

EP - 477

JO - Asian Journal of Andrology

JF - Asian Journal of Andrology

SN - 1008-682X

IS - 4

ER -