Rigi10™ Malleable Penile Prosthesis
Also Known As
Leukospermia, Pyospermia
Definition
Leukocytospermia is defined as the presence of an abnormally high concentration of white blood cells (leukocytes) in semen, specifically exceeding 1 × 106 leukocytes per milliliter of ejaculate, according to the World Health Organization criteria.1 This condition represents an inflammatory state within the male reproductive tract that may indicate underlying infection, inflammation, or other pathological processes.2 The excessive presence of leukocytes can generate reactive oxygen species (ROS), which may damage sperm cell membranes, impair sperm function, and potentially compromise fertility outcomes.3 Leukocytospermia is found in both fertile and infertile men, though it appears more frequently in the latter group, affecting approximately 30% of infertile males.4
Clinical Context
Leukocytospermia is clinically significant in the evaluation and management of male infertility.1 The condition is diagnosed through several methods, with immunohistochemical staining using monoclonal antibodies considered the gold standard, though peroxidase staining is more commonly used in clinical practice due to its practicality.2 Other diagnostic approaches include the Endtz test, flow cytometry, and seminal granulocyte elastase testing.3
The etiology of leukocytospermia is multifactorial, including genital tract infections (bacterial or viral), inflammation without infection, varicocele, smoking, and trauma such as spinal cord injury.4 Interestingly, in approximately 80% of leukocytospermic infertile males, no microbial infection can be detected despite the inflammatory response.2
Clinically, leukocytospermia has been associated with impaired spermatogenesis, reduced sperm motility, defects in sperm tail function, and higher rates of teratoasthenozoospermia and necrozoospermia.2 The condition may hinder the fertilization potential of spermatozoa by interfering with the acrosome reaction and sperm-egg fusion processes.3 The primary mechanism of damage appears to be through leukocyte-generated reactive oxygen species, which can cause lipid peroxidation of sperm cell membranes rich in polyunsaturated fatty acids.3
Treatment approaches vary based on suspected etiology and include antibiotics (tetracyclines, quinolones, macrolides) for suspected infections, anti-inflammatory agents, antioxidants, and lifestyle modifications such as smoking cessation.5 In cases where leukocytospermia impacts fertility outcomes, assisted reproductive technologies may be considered, with special attention to sperm preparation techniques that can separate sperm from white blood cells.4