Андрология и генитальная хирургия. 2016; 17: 98-103
Влияние бессимптомных инфекций урогенитального тракта на показатели эякулята у мужчин с бесплодием и варикоцеле
https://doi.org/10.17650/2070-9781-2016-17-2-98-103Аннотация
Варикоцеле – патология, которой страдают около 15 % мужчин. С ним ассоциированы до 30 % всех случаев мужского бесплодия. Роль сопутствующих инфекций урогенитального тракта (УГТ) при бесплодии в сочетании с варикоцеле недостаточно изучена.
Цель работы – оценка влияния бактериально-вирусных инфекций УГТ на показатели эякулята у пациентов с бесплодием и варикоцеле. Обследованы 49 больных бесплодием и варикоцеле и 26 практически здоровых мужчин, обратившихся для профилактического обследования. При исследовании эякулятов и соскобов из уретры среди 49 пациентов был выявлен высокий уровень инфицированности УГТ бактериальными (30,6 %) и вирусными (14,3 %) патогенами. Количественный анализ вирусной ДНК показал, что концентрация герпес-вирусов в эякуляте была высокой (> 3 lg10/мл). При детальном изучении спермограмм обнаружено, что у пациентов с бесплодием и варикоцеле все основные показатели были снижены по сравнению с аналогичными данными у здоровых мужчин; присутствие инфекционных агентов оказывало дополнительное статистически значимое ухудшение качества эякулята. По данным спермиологического исследования установлено повышенное количество сочетанных форм патозооспермии (астенотератозооспермия, олиготератозооспермия, олигоастенотератозооспермия) у пациентов с бесплодием, варикоцеле и бактериально-вирусной инфекцией УГТ по сравнению с неинфицированными пациентами с бесплодием и варикоцеле. При мужском бесплодии, ассоциированном с варикоцеле, можно рекомендовать проведение лабораторной диагностики бактериальных и вирусных патогенов, наиболее часто встречающихся в УГТ мужчин даже при отсутствии клинических признаков инфекции. Количественный анализ патогенов в УГТ, выполненный до лечения варикоцеле, позволит определить необходимость этиотерапии скрытой инфекции.
Список литературы
1. Pajovic B., Dimitrovski A., Radojevic N., Vukovic M. Comparison of sperm parameters in patients with infertility induced by genital infection versus varicocele. Balcan Med J 2015;32(3):255–9.
2. Timpano M., Fontana D., Rolle L. et al. Sperm collection for medically assisted procreation in azoospermic patients. Urologia 2014;81(Suppl 23):27–31.
3. Dada R., Kumar M., Jesudasan R. et al. Epigenetics and its role in male infertility. J Assist Reprod Genet 2012;29(3):213–23.
4. Poongothai J., Gopenath T. S., Manonayaki S. Genetics of human male infertility. Singapore Med J 2009;50(4): 336–7.
5. Dubin L., Amelar R. D. Etiologic factors in 1294 consecutive cases of male infertility. Fertil Steril 1971;22(8):469–74.
6. Schlesinger M. H., Wilets I. F., Nagler H. M. Treatment outcome after varicocelectomy. A critical analysis. Urol Clin North Am 1994;21(3):517–29.
7. Nagler H. M., Luntz R. K., Martinis F. G. Varicocele. By eds.: L. I. Lipshultz, S. S. Howards. In book: Infertility in the male. 3rd ed. St. Louis, Mis souri: Mosby-Year Book, 1997. Pp. 336–359.
8. Cayan S., Shavakhabov S., Kadioglu A. Treatment of palpable varicocele in infertile men: A meta-analysis to define the best technique. J Androl 2009;30(1):33–40.
9. Cantoro U., Polito M., Muzzonigro G. Reassessing the role of subclinical varicocele in infertile men with impaired semenquality: a prospective study. Urology 2015;85(4):826–30.
10. Fraczek M., Kurpisz M. Mechanisms of the harmful effects of bacterial semen infection on ejaculated human spermatozoa: potential inflammatory markers in semen. Folia Histochem Cytobiol 2015;53(3): 201–17.
11. Kapranos N., Petrakou E., Anastasiadou C., Kotronias D. Detection of herpes simplex virus, cytomegalovirus, and Epstein–Barr virus in the semen of men attending an infertility clinic. Fertil Steril 2003;79(3):1566–70.
12. Ochsendorf F. R. Sexually transmitted infections: impact on male fertility. Andrologia 2008;40(2):72–5.
13. World Health Organization. WHO Laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization. 2010.
14. Kamal K. M., Javeri K., Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril 2001;75(5):1013–6.
15. Baazeem A., Belzile E., Ciampi A. et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol 2011;60(4):796–808.
16. Pajovic B., Radojevic N., Vukovic M., Stjepcevic A. Semen analysis before and after antibiotic treatment of asymptomatic Chlamydia- and Ureaplasma-related pyospermia. Andrologia 2013;45(4):266–71.
17. Ma H. G., Zhao W. J., Lu H. K. Semen quality and sperm ultrastructure in infertile men with varicocele. Zhonghua Nan Ke Xue 2013;19(8):704–9.
18. Hart R. J., Doherty D. A., McLachlan R.I. et al. Testicular function in a birth cohort of young men. Hum Reprod 2015;30(12):2713–24.
19. Fraczek M., Kurpisz M. Inflammatory mediators exert toxic effects of oxidative stress on human spermatozoa. J Androl 2007;28(2):325–33.
20. Vicari E., Arcoria D., Di Mauro C. et al. Sperm output in patients with primary infertility and hepatitis B or C virus; negative influence of HBV infection during concomitant varicocele. Minerva Med 2006;97(1):65–77.
Andrology and Genital Surgery. 2016; 17: 98-103
Impact of asymptomatic urogenital tract infections on ejaculate parameters in infertile men with varicocele
https://doi.org/10.17650/2070-9781-2016-17-2-98-103Abstract
Varicocele, a pathology developing in 15 % males, is associated with 30 % male infertility cases. The role of urogenital infections coinciding with varicocele in infertile men has not been studied in sufficient detail.
Objective: to examine the effects of bacterial and viral infections on ejaculate parameters in infertile patients with varicocele. The study included 49 patients with infertility and varicocele and 26 healthy males undergoing prophylactic medical examination. Highlevel infection was recorded after examination of ejaculates and urethral scrapes of 49 patients: bacterial (30.6 %) and viral (14.3 %) pathogens. Quantitative analysis of viral DNA showed high contamination of ejaculates with herpes viruses (> 3 lg10/ml). Detailed analysis of spermatograms demonstrated a decrease in all basic parameters in patients with varicocele and infertility compared with those in healthy subjects. The presence of infectious agents had a statistically significant negative effect on ejaculate parameters. Spermiological examination revealed high level of sperm abnormalities (astenozoospermia, oligoteratozoospermia, and oligoastenoteratozoospermia) in patients with infertility, varicocele and bacterioviral infection of urogenital tract compared with uninfected infertile patients with varicocele. Laboratory tests for bacterial and viral infections should be recommended in infertility associated with varicocele even in the absence of clinical signs of these infections. Quantitative analysis of urogenital pathogens allows one to determine the necessity of etiotherapy of hidden infection and to monitor the effectiveness of treatment.
References
1. Pajovic B., Dimitrovski A., Radojevic N., Vukovic M. Comparison of sperm parameters in patients with infertility induced by genital infection versus varicocele. Balcan Med J 2015;32(3):255–9.
2. Timpano M., Fontana D., Rolle L. et al. Sperm collection for medically assisted procreation in azoospermic patients. Urologia 2014;81(Suppl 23):27–31.
3. Dada R., Kumar M., Jesudasan R. et al. Epigenetics and its role in male infertility. J Assist Reprod Genet 2012;29(3):213–23.
4. Poongothai J., Gopenath T. S., Manonayaki S. Genetics of human male infertility. Singapore Med J 2009;50(4): 336–7.
5. Dubin L., Amelar R. D. Etiologic factors in 1294 consecutive cases of male infertility. Fertil Steril 1971;22(8):469–74.
6. Schlesinger M. H., Wilets I. F., Nagler H. M. Treatment outcome after varicocelectomy. A critical analysis. Urol Clin North Am 1994;21(3):517–29.
7. Nagler H. M., Luntz R. K., Martinis F. G. Varicocele. By eds.: L. I. Lipshultz, S. S. Howards. In book: Infertility in the male. 3rd ed. St. Louis, Mis souri: Mosby-Year Book, 1997. Pp. 336–359.
8. Cayan S., Shavakhabov S., Kadioglu A. Treatment of palpable varicocele in infertile men: A meta-analysis to define the best technique. J Androl 2009;30(1):33–40.
9. Cantoro U., Polito M., Muzzonigro G. Reassessing the role of subclinical varicocele in infertile men with impaired semenquality: a prospective study. Urology 2015;85(4):826–30.
10. Fraczek M., Kurpisz M. Mechanisms of the harmful effects of bacterial semen infection on ejaculated human spermatozoa: potential inflammatory markers in semen. Folia Histochem Cytobiol 2015;53(3): 201–17.
11. Kapranos N., Petrakou E., Anastasiadou C., Kotronias D. Detection of herpes simplex virus, cytomegalovirus, and Epstein–Barr virus in the semen of men attending an infertility clinic. Fertil Steril 2003;79(3):1566–70.
12. Ochsendorf F. R. Sexually transmitted infections: impact on male fertility. Andrologia 2008;40(2):72–5.
13. World Health Organization. WHO Laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization. 2010.
14. Kamal K. M., Javeri K., Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril 2001;75(5):1013–6.
15. Baazeem A., Belzile E., Ciampi A. et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol 2011;60(4):796–808.
16. Pajovic B., Radojevic N., Vukovic M., Stjepcevic A. Semen analysis before and after antibiotic treatment of asymptomatic Chlamydia- and Ureaplasma-related pyospermia. Andrologia 2013;45(4):266–71.
17. Ma H. G., Zhao W. J., Lu H. K. Semen quality and sperm ultrastructure in infertile men with varicocele. Zhonghua Nan Ke Xue 2013;19(8):704–9.
18. Hart R. J., Doherty D. A., McLachlan R.I. et al. Testicular function in a birth cohort of young men. Hum Reprod 2015;30(12):2713–24.
19. Fraczek M., Kurpisz M. Inflammatory mediators exert toxic effects of oxidative stress on human spermatozoa. J Androl 2007;28(2):325–33.
20. Vicari E., Arcoria D., Di Mauro C. et al. Sperm output in patients with primary infertility and hepatitis B or C virus; negative influence of HBV infection during concomitant varicocele. Minerva Med 2006;97(1):65–77.
