SEMEN QUALITY AND CHRONIC: ABACTE KIAI, PROSTATITIS ‘ii) tllc Witor: The December 1991 article b!. Chris1ianwn. ‘lbllefsrud, and Purvis’ reports an associat ion t&u. tan impaired semen quality and chronic abacterial prostatitis. They report that total sperm c9unt and sperm concentration as ~vell as sperm motility and morphology were impaired in men \\rith abacterial prostatitis, but ejaculate volunie was
7i1 t/w Editor: III the article. “IXagnostic Lbcfulness c:f I’ost-Void Film in Intravenorls Program.” b) K. Il. Vydaren!,. K. J. Stuck. J, H. Ellis. LIIK~D. A. 0111. puhlishrcl in the August issw (\wl. 35. pap 1X-1’i3. 19Uli 4 I~IK)I.O(:Y. the allttlor\ assess thcl usc~fulness of the post-void filnl in excretory. urograph>. (intravenous urograph~~). The\. appropriatel! conclude that this phase of the stud!. chould be reser\.ed for specific situations \vherc this information w~~uld like]!. influence the cart’ of the paticwt. \2+ should ol)tain the niaxinillm iIlfornwtion from any radiologic study. In addition to the post-\ oid film. in selected cases thcx IVP sho111cl also inclllde a film during voiding. Essentially an antegmdc voiclthis film C~II delineate a ing c!,stclllrt~ttlroaralil, Iirethral strictllre or diverticiill~rn in a rioviri?.dsive manner. H!- a\Gding urethral instCumentatit’n \\ith possible sccondar!- spasms. om~ nla>’ get 2 tiiorc ac’curatr pictllrc of the urethral configuratioll. partic ularl\- in cases of urethral strictuw. Sil;iilarl!.. this can be used as a scwening stlld! for Iircterovesical reflux. particrllarl\. ilk children in the pr~wedllre is. tlw better. \vhom tlw less in\&\-e The presence of llwteral dilatation on the, lwiding film. the tirnc* of maximum intra\ cGca1 I)ressure, ~vor~lcl slipl)ort the prol,atClit> of rlncl~~rlyirig reflus. \\~hen ordering an!’ radiologic stlId\: Therefore. the ph!xician should be a\vare of the lmtrwtial information that can Iv2 gained t,y that stlid!. alid instruct the radiologist in the necessary rliodifi~ations. UIIdoubtecll\~ manv of ollr collcagr~es alwad\. utilize these techniques and have discwwwl. a$#have WY’, that the!, ha\~ decreased trauma to both the psyches acid the Ilrvthras of their paticmts.
rtnaffected. l’llese findings are explained as due to c+her (1) secondary nonspecific reaction in the rel)rodtlcti\,e tract being induced by prostatic inflamInation. (2) syjread of a “silent” infection to testis or (pididymis, (3) occlusion or interference Lvith function of thus ejaculator): ducts. or (4) disturbances in accessory sex gland frmction. The decrease in sperm c,onccmtration and total sperm count in these men suggest that sperm production is impaired. The alternative explanation. partial obstruction of the rel)roducti\;ca tract _ seems unlikely in the face of an otherwise unaffected ejaculate volume. Ohsl ruction of the epididyrnis is also possible. An alternative explanation for the findings clescribecl in this study is that treatment for chronic I)rostatitis may have caused the impaired frrtilit! c!escribetl. I,ong-term treatment with variolls antibiotics is commonly provided for men with cxhronic abacterial prostatitis. Many antibiotics ha\,e been well documented to affect spermatogencsis and sperm function.” In vielv of these facts. and preliminary findings from Israel (C. Servadio. personal c,omrnunication. 1991) that nonantibiotic treatnwnt of men with chronic prostatitis may improw semen rluality. it is possible that the impairment iI1 sperm citlalitp associated with chronic prostatitis may 1~ cLaused b\, its trwtment with antibiotics. This fLlding should be considered 1)~ thaw clincians who are consulted for evaluation of irifertilit! III men v;ith symptoms suggestive of chronic 1nwstatitis. \\:it holut a doclnnented bacterial infechtion or pyosptm[~ia. Peter ru‘. Schlegcl, M.D. Assistant Professor of Surgerv (Urolog>.) ‘l‘lw Nt~\v York Hospital-Cornell Me&al Center 525 F:ast 68th Street Kwv York. Next, York 10021
CURABlLIT1’
OF PATIENTS
M’ITH PROSTATE
CANCER Zi) fhc Z2ilor: In a recent article on “Prognostic significance of extent of nodal in\wl\.ement in Stage Dl prostate> cancer treated \vith rwdic,therap).” ptihlished in the January issue (vol. .3!). 11ag[c’39-43, s 1992) of ~~HoI.o(;Y_the authors. S. M. Anscllt~r and I,. R. I’rosnitz. correlate the extthnt of nodal disease to
I’HoI.o(;>
AI’HI I, I!W”
\‘ol.U21t’:
SSSll
Sl’hll3F.H
I
3115
7i1 t/w Editor: III the article. “IXagnostic Lbcfulness c:f I’ost-Void Film in Intravenorls Program.” b) K. Il. Vydaren!,. K. J. Stuck. J, H. Ellis. LIIK~D. A. 0111. puhlishrcl in the August issw (\wl. 35. pap 1X-1’i3. 19Uli 4 I~IK)I.O(:Y. the allttlor\ assess thcl usc~fulness of the post-void filnl in excretory. urograph>. (intravenous urograph~~). The\. appropriatel! conclude that this phase of the stud!. chould be reser\.ed for specific situations \vherc this information w~~uld like]!. influence the cart’ of the paticwt. \2+ should ol)tain the niaxinillm iIlfornwtion from any radiologic study. In addition to the post-\ oid film. in selected cases thcx IVP sho111cl also inclllde a film during voiding. Essentially an antegmdc voiclthis film C~II delineate a ing c!,stclllrt~ttlroaralil, Iirethral strictllre or diverticiill~rn in a rioviri?.dsive manner. H!- a\Gding urethral instCumentatit’n \\ith possible sccondar!- spasms. om~ nla>’ get 2 tiiorc ac’curatr pictllrc of the urethral configuratioll. partic ularl\- in cases of urethral strictuw. Sil;iilarl!.. this can be used as a scwening stlld! for Iircterovesical reflux. particrllarl\. ilk children in the pr~wedllre is. tlw better. \vhom tlw less in\&\-e The presence of llwteral dilatation on the, lwiding film. the tirnc* of maximum intra\ cGca1 I)ressure, ~vor~lcl slipl)ort the prol,atClit> of rlncl~~rlyirig reflus. \\~hen ordering an!’ radiologic stlId\: Therefore. the ph!xician should be a\vare of the lmtrwtial information that can Iv2 gained t,y that stlid!. alid instruct the radiologist in the necessary rliodifi~ations. UIIdoubtecll\~ manv of ollr collcagr~es alwad\. utilize these techniques and have discwwwl. a$#have WY’, that the!, ha\~ decreased trauma to both the psyches acid the Ilrvthras of their paticmts.
rtnaffected. l’llese findings are explained as due to c+her (1) secondary nonspecific reaction in the rel)rodtlcti\,e tract being induced by prostatic inflamInation. (2) syjread of a “silent” infection to testis or (pididymis, (3) occlusion or interference Lvith function of thus ejaculator): ducts. or (4) disturbances in accessory sex gland frmction. The decrease in sperm c,onccmtration and total sperm count in these men suggest that sperm production is impaired. The alternative explanation. partial obstruction of the rel)roducti\;ca tract _ seems unlikely in the face of an otherwise unaffected ejaculate volume. Ohsl ruction of the epididyrnis is also possible. An alternative explanation for the findings clescribecl in this study is that treatment for chronic I)rostatitis may have caused the impaired frrtilit! c!escribetl. I,ong-term treatment with variolls antibiotics is commonly provided for men with cxhronic abacterial prostatitis. Many antibiotics ha\,e been well documented to affect spermatogencsis and sperm function.” In vielv of these facts. and preliminary findings from Israel (C. Servadio. personal c,omrnunication. 1991) that nonantibiotic treatnwnt of men with chronic prostatitis may improw semen rluality. it is possible that the impairment iI1 sperm citlalitp associated with chronic prostatitis may 1~ cLaused b\, its trwtment with antibiotics. This fLlding should be considered 1)~ thaw clincians who are consulted for evaluation of irifertilit! III men v;ith symptoms suggestive of chronic 1nwstatitis. \\:it holut a doclnnented bacterial infechtion or pyosptm[~ia. Peter ru‘. Schlegcl, M.D. Assistant Professor of Surgerv (Urolog>.) ‘l‘lw Nt~\v York Hospital-Cornell Me&al Center 525 F:ast 68th Street Kwv York. Next, York 10021
CURABlLIT1’
OF PATIENTS
M’ITH PROSTATE
CANCER Zi) fhc Z2ilor: In a recent article on “Prognostic significance of extent of nodal in\wl\.ement in Stage Dl prostate> cancer treated \vith rwdic,therap).” ptihlished in the January issue (vol. .3!). 11ag[c’39-43, s 1992) of ~~HoI.o(;Y_the authors. S. M. Anscllt~r and I,. R. I’rosnitz. correlate the extthnt of nodal disease to
I’HoI.o(;>
AI’HI I, I!W”
\‘ol.U21t’:
SSSll
Sl’hll3F.H
I
3115
