Magri Vittorio, Wagenlehner Florian M E, Montanari Emanuele, Marras Emanuela, Orlandi Viviana, Restelli Antonella, Torresani Erminio, Naber Kurt G, Perletti Gianpaolo
Urology and Sonography Primary Care Clinic, Hospital Istituti Clinici di Perfezionamento, Milano, Italy.
Asian J Androl. 2009 Jul;11(4):461-77. doi: 10.1038/aja.2009.5. Epub 2009 Apr 20.
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.
精液分析在慢性细菌性前列腺炎中的意义及诊断价值一直存在广泛争议且尚无定论。为研究精液培养在前列腺炎患者细菌学检查中的诊断相关性，我们回顾性分析了696例有症状患者的临床数据库。所有患者均常规接受四杯试验，随后进行精液培养和分析。这使得我们能够从数据库中剖析出三种不同的诊断方案，并将“两杯”按摩前后试验以及标准的“四杯”试验与“五杯”试验（四杯加VB3后精液培养）进行比较。与四杯或两杯试验相比，“五杯”试验对传统尿路病原体（TUs）的相对敏感性分别提高了3.6倍或6.5倍，相对特异性降低幅度较小（分别为-13.2%或-14.7%）。ROC曲线下面积和尤登指数增加，而阳性和阴性似然比低于对照试验，表明“五杯”检测在确认两种标准检测的阴性结果方面可能更具优势。五杯、四杯和两杯试验分别在120例、33例和20例患者中检测到TUs（肠杆菌科、肠球菌等），在130例、56例和45例患者中检测到非典型病原体（链球菌、其他革兰氏阳性菌、支原体等）。当患者接受包括氟喹诺酮和大环内酯联合用药的药物治疗时，无论病原体类别如何，不同检测诊断出的组间根除率均无差异。根除与长期体征/症状缓解相关；在24个月的停药随访期内，组间体征/症状评分无显著差异。总之，我们的数据支持在将该检测用于补充四杯Meares和Stamey试验时，精液分析在前列腺炎患者诊断检查中的有用性。微生物检测方法的改进具有重要的诊断和治疗意义。
