[Urinalysis] Sperm

                                          Image by Cooldesign, from FreeDigitalPhotos.net

When we take a look at urine under the microscope, there are things we tend to look for. Most of them seem pretty clear cut on why they are reportable - they are signs of infection or conditions that the doctors can then treat. Bacteria, and WBC are both obvious signs of urinary tract infections; yeast signal a yeast infection. White cells casts can predict pyelonephritis, and red cell casts glomerulonephritis.

 But what about sperm?

Shouldn't sperm be something we see in every male midstream sample?

Nope.

Spermatozoa are only normal if the sample isn't midstream, AND the patient has had sexual activity within five hours of collection. As collection protocol for urinalysis is midstream, we should not expect to see sperm in sample.

Sperm is seen in midstream urine when the bladder sphincter fails to produce the usual tightening before ejaculation. The sperm then travel into the bladder instead of out of the body, and are excreted during urination. This condition is called retrograde ejaculation, and can be due to nerve damage, diabetes, medication side effect, post bladder/prostate surgery, or weak muscle condition. This is one of the more common causes of male infertility, and can be treated.

Another reason sperm may be seen in male patients' urine is prostatitis. When the prostate is swollen with fluid, it can block off the paths that sperm would normally travel, causing a redirect. This can be due to prostate cancer, recent surgery, bacterial infection of the prostate or urinary system, or arousal without ejaculation. Sometimes this is also seen when methods to avoid mess are used in sexual expression; the interference (or application of Hughes Method) to prevent ejaculation can cause backflow into the bladder. Unless other symptoms are present, treatment is generally unnecessary.

Reporting sperm in male urine can be a real clue to infertility patients

.What about females and children though? You should never see sperm in a child's urine. If you do, you must report it; that child could be sexually abused. I would advise confirming with a second sample if you can, to ensure there are no mistakes. Know that you cannot be sued for bringing this to your hospitals' attention so they can follow up; this is part of your duty to report as a technologist. In one case, the parents attempted to sue, but failed. Seeing sperm in an adult female's sample is a non-clinical finding.