[Infections and male infertility]

BACKGROUND

The role of urogenital infections in male infertility has long been the subject of debate.

METHODS

A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles.

RESULTS

Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved.

CONCLUSION

This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.

[Epidemiology of urological emergencies in France]

INTRODUCTION

To report the epidemiology and the care pathway for urological emergencies in France for the official report of the 115th Congres Francais d'Urologie.

METHODS

We made a request to the Institut de Veille Sanitaire and its network Surveillance Sanitaire des Urgences et des Décès (SurSaUD®). Within this system, the OSCOUR® network (Organisation de la surveillance coordonnée des urgences) centralizes in real time the data of emergency visits from more than 720 emergency departments throughout the national territory (>93% of the national territory covered by the OSCOUR® network). For each emergency defined by its CIM-10 code, the following data were collected from 2014 to 2019: age, gender, length of stay and post-emergency status (hospitalization vs. return home).

RESULTS

From 2014 to 2019, urological emergencies represented on average 4.2% of all emergencies, with an average 591,080±66,782 passages/year including 25% that resulted in hospitalization. Infectious disease represented 35% of all urological emergencies. The 3 most common urologic emergencies were: renal colic, acute urine retention and hematuria for men; acute cystitis, pyelonephritis and renal colic for women.

CONCLUSION

In an analysis of the OSCOUR® (Organisation de la surveillance coordonnée des urgences) registry, we determined the epidemiological profiles of the main urological emergencies with contemporary data.

[An abscessed granulomatous prostatitis]

INTRODUCTION

Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis.

CASE REPORT

A 55-year-old man was admitted for acute urinary retention. Urine culture was sterile, with leukocyturia > 10⁶/ml. After failure of antibiotic therapy with cefotaxime, CT scan revealed a necrotic prostatic collection and a nodular non-necrotic tissular lesion in the left upper lung lobe. Trans-rectal drainage of the prostatic lesion and lung biopsies revealed granuloma with multinucleated giant cells (without mycobacteria). The diagnosis of granulomatosis with polyangiitis was confirmed by high level of anti-proteinase 3 antibodies. Treatment with steroids and rituximab resulted in apyrexia, regression of the inflammatory syndrome and clinical manifestations.

CONCLUSION

The diagnosis of granulomatosis with polyangiitis should be considered in the presence of a non-infectious granulomatous prostatitis with systemic involvement.

[Bacteriological analysis of more than 600 febrile urinary infections managed in a community health network]

Community-acquired febrile urinary tract infections (UTI) in adult has received little attention in the literature. The objective of our study was to determinate the distribution of bacterial strains isolated from adults with community-acquired febrile UTI and antibiotic susceptibility patterns of Escherichia coli.

PATIENTS AND METHOD

We studied the SPHERES's databank. SPHERES is a Parisian medical community network aimed at securing and facilitating the ambulatory management of potentially serious acute illnesses. Each patient is included in the network according to specific clinical criteria and standardized medical data are recorded. We retrospectively studied the medical records of all patients treated for a pyelonephritis or a prostatitis between April 2005 and October 2008.

RESULTS

Five hundred and sixty-eight patients were enrolled: 410 women and 158 men. The overall bacteria's distribution was similar to that observed in previous strictly microbiological studies with a more prominent role of E. coli (87.5%) to the detriment of other species. The overall susceptibility of E. coli to antibiotics recommended in the empiric treatment of pyelonephritis and prostatitis was preserved: ciprofloxacin (95.8%), cefotaxime (98%), gentamicin (99.4%). In women over 65 years, the susceptibility of E. coli to systemic fluoroquinolones fell up 89.7%. This could affect the empiric oral treatment of pyelonephritis in older women.

CONCLUSIONS

We report the bacterial distribution and the resistance pattern of bacteria implicated in febrile urinary infections diagnosed and treated in a health network. It seems that E. coli resistance increased more in women more than 65 years than in men.