背景:血精症最常见的已知原因是泌尿生殖道感染,但目前还没有研究全面调查急性附睾炎患者的血精。
目的:评估血精对急性附睾炎患者的影响及其与临床,微生物和精液参数。
方法:自2007年5月以来,在一项前瞻性队列研究中招募了324名性活跃的急性附睾炎患者。患者接受了全面的病史和性史,临床,超声检查,实验室和微生物诊断。根据EAU指南给予抗生素治疗。首次治疗和开始治疗后14天提供精液分析。自2013年以来,前瞻性招募了一个由56名表现为孤立性血精症(=无其他泌尿生殖症状)的患者组成的单独对照组,并对组间差异进行统计学评价。
结果:在324例急性附睾炎患者中,50例患者(15%)自我报告有血精症。这发生在阴囊症状发作前24小时的中位数,与274例无血精症患者相比,PSA水平显着升高(3.1vs.1.8ng/ml,p<0.01)。两种最常见的病原为大肠埃希菌和沙眼衣原体,并且两个附睾炎亚组的细菌谱具有可比性(p=0.859)。14天时的精液分析仍显示24%的患者伴有大量白细胞精子症。与血精对照组相比,两个附睾炎亚组显示炎症标志物显著增加(pH,白细胞,弹性蛋白酶),精子浓度降低,和降低的α-葡萄糖苷酶和锌的水平(总是p<0.01)。
结论:在发生急性附睾炎的性活跃患者中,15%的患者早在阴囊症状出现前一天就出现了明显的自报血精症.相反,出现孤立性血精症的56例患者在接下来的4周内均未出现附睾炎.本文受版权保护。保留所有权利。
BACKGROUND: Among the most commonly known causes of
hematospermia are infections in the genitourinary tract, but no study exists that has comprehensively investigated
hematospermia in patients with acute epididymitis.
OBJECTIVE: To assess the impact of
hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters.
METHODS: Since May 2007, a total of 324 sexually active patients with acute epididymitis were recruited in a prospective cohort study. Patients received a comprehensive medical and sexual history, and clinical, sonographic, laboratory, and microbiological diagnostics. Antibiotic therapy was given according to European Association of Urology guidelines. Semen analysis was offered 14 days after the first presentation and initiation of therapy. Since 2013, a separate control group of 56 patients presenting with isolated
hematospermia (= no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated.
RESULTS: Of 324 patients with acute epididymitis, 50 patients (15%) had self-reported hematospermia. This occurred with a median of 24 h before the onset of scrotal symptoms and was associated with significantly elevated prostate-specific antigen levels compared to 274 patients without hematospermia (3.1 vs. 1.8 ng/ml, p < 0.01). The two most common etiological pathogens were Escherichia coli and Chlamydia trachomatis, and the bacterial spectrum was comparable in both epididymitis subgroups (p = 0.859). Semen analysis at 14 days still showed hematospermia in 24% of patients associated with massive leukocytospermia. Compared to the hematospermia control group, the two epididymitis subgroups showed significantly increased inflammation markers (pH, leukocytes, and elastase), reduced sperm concentration, and reduced levels of alpha-glucosidase and zinc (always p < 0.01).
CONCLUSIONS: In sexually active patients who develop acute epididymitis, self-reported hematospermia is evident in 15% of patients as early as one day before the onset of scrotal symptoms. Conversely, none of the 56 patients presenting with isolated
hematospermia developed epididymitis within the next 4 weeks.