Prostate; How does prostatitis affect male fertility?

What is prostatitis?

Bacterial prostatitis is a clinical condition caused by a bacterial infection of the prostate that produces urinary symptoms and affects male fertility.

What are the prostatitis causes?

The causative germs are detected by routine methods in only 5-10% of cases, whereby antimicrobial therapy in these patients has, therefore, a rational basis. Impaired bladder emptying due to narrowing of the urethra is often the cause of prostatitis.

All other patients are treated empirically with numerous medical and physical modalities. However, recent improvement in the classification and application of modern methods, including molecular biology, should allow a proper systematisation of treatment.

What types of prostate infections are there?

The germs that cause them are usually bacteria of intestinal origin, especially E. coli, and are predominant in acute bacterial prostatitis. In chronic bacterial prostatitis, the spectrum of germs is broader and their presence in semen and urine must be studied.

Can prostatitis cause infertility?

Prostatitis causes infertility by altering the spermiogram due to inflammation of the seminal tract, which can lead to obstructive azoospermia, i.e. the absence of spermatozoa in the sediment due to obstruction. Obstructive azoospermia is less common than non-obstructive azoospermia (where no sperm are produced) and occurs in 20-40% of men with azoospermia.

Obstruction within the testis occurs in 15% of men with obstructive azoospermia. Epididymal obstruction is the most common cause of obstructions and affects 30-67% of azoospermic men.

Epididymitis that is associated without symptoms with prostatitis (e.g. chlamydia) is most often due to prostatic infections.

There are two key aspects to prostatitis: the treatment of symptoms, nocturia, perineal pain, sensation of incomplete emptying, which in some cases are very tedious, evolving into outbreaks, and the improvement of seminal quality in cases where fertility is compromised.

For the former, factors of the infecting germ and the patient’s (immunity and defence mechanisms) have an influence. In addition, symptomatology conditioning factors such as stress, irrational weight loss diets, which indirectly condition the defence mechanisms, also play a role.

In terms of fertility, a complete urological diagnostic study, with cystourethrography, microbiological examination and appropriate treatment with bacteriostatic antibiotics that have a good target in the prostate (as all antibiotics do not reach the prostate) can in some cases improve seminal quality.

Is it possible to have children after radical surgery for prostate cancer?

A urological evaluation would be required and yes, sperm can be obtained in patients with this history and a successful cycle of assisted reproduction can be developed. Patients who have undergone radiotherapy or hormone blockade may have difficulties or even fail to obtain sperm. On the other hand, those who have previously had children and have only undergone surgery, with no other history of testicular pathology, should have no problems.

Is it possible to have children after being operated on for prostate adenoma and not having ejaculate as a result of this surgery?

After surgery for benign prostatic hyperplasia, if there is no history of testicular pathology, and no 5 alpha-reductase inhibitors or hormonal treatments have been taken, sperm can be obtained by means of sperm collection techniques (testicular puncture, testicular biopsy) and pregnancy can be achieved through our assisted reproduction techniques, as in the previous case.

Is it possible to have children after undergoing chemotherapy for cancer?

This question is generic and the answer varies depending on the type of tumour and the chemotherapy given. These patients require a thorough evaluation and yes, in some cases sperm can be obtained.  There are also cases in which sperm cannot be obtained, especially when they have combinations of chemotherapy and additional radiotherapy. If sperm are obtained, if their quality is suitable, they can be frozen and used at a later date.

Dr. Luis Prieto, urologist at Instituto Bernabeu.