Inflammatory‐associated obstructions of the male reproductive tract
Inflammatory‐associated obstructions of the male reproductive tract
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DOI：
10.1111/j.1439-0272.2003.tb00866.x
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发表时间：
2003-10
期刊：
影响因子：
2.4
通讯作者：
G. Dohle
中科院分区：
文献类型：
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作者：
G. Dohle
摘要泌尿生殖道炎症的历史发生在5 - 12%的男性参加不孕症诊所。通常，感染通过降低浓度和活力对精子质量产生不利影响，并可能影响形态正常的精子数量。此外，感染可能是抗精子自身抗体的来源，在约8%的不育男性人群中发现。与妇女的情况相反，没有明确的证据表明男性附腺感染会导致附睾阻塞或血管阻塞，生殖器结核除外。虽然沙眼衣原体是慢性前列腺炎的一个有据可查的来源，但这种感染似乎不会像女性那样引起生殖道阻塞。如果男性泌尿生殖道感染导致梗阻，则最有可能位于射精管水平。慢性前列腺炎已被证明会导致前列腺和射精管的瘢痕形成，导致低果糖和α-葡萄糖苷酶的低精液量。这些男性中的许多人表现为严重的少精子症或无精子症，正常大小的睾丸和正常的促性腺激素。我们对每毫升精子数<100万的所有男性进行了睾丸切除活检，发现78例中有39例（50%）精子发生正常。在12%的男性中发现男性附件生殖器感染史，10%的男性在经直肠超声检查中发现前列腺异常（如水肿、精囊和射精管扩张），前列腺内钙化和前列腺周围静脉丛扩张。射精管阻塞是男性不育的常见原因，至少22 - 50%的男性存在感染。经尿道射精管切除术可能会导致精子质量的显着改善和高达25%的夫妇自发妊娠。在失败的情况下，附睾精子抽吸和卵胞浆内单精子注射是治疗的选择。
Summary. A history of urogenital inflammation occurs in 5–12% of men attending infertility clinics. Usually, infection has a detrimental effect on sperm quality by reducing concentration and motility, and possibly affecting the number of morphological normal spermatozoa. In addition, infection may be the source of auto‐antibodies against spermatozoa, found in about 8% of the infertile male population. In contrast to the situation in women, there is no clear evidence that male accessory gland infections can result in epididymal blockage or vassal obstruction, with the exception of genital tuberculosis. Although Chlamydia trachomatis is a well‐documented source of chronic prostatitis, the infection does not seem to cause obstruction of the reproductive tract, as it does in women. If male urogenital infection causes obstruction it is most likely located at the level of the ejaculatory ducts. Chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts, resulting in low seminal volume with low fructose and alpha‐glucosidase. Many of these men present with severe oligozoospermia or azoospermia, normal size testis and normal gonadotrophins. We performed an excisional testicular biopsy in all men presenting with <1 million spermatozoa per millilitre and found that 39 of 78 (50%) had a normal spermatogenesis. A history of male accessory genital infection was found in 12% of the men and 10% had abnormalities found on transrectal ultrasound of the prostate (like oedema, dilatation of the seminal vesicles and ejaculatory ducts) intraprostatic calcifications and dilatation of the periprostatic venous plexus. Ejaculatory duct obstruction is a common cause of male infertility and infections are present in at least 22–50% of these men. Transurethral resection of the ejaculatory ducts may result in a significant improvement of the sperm quality and in spontaneous pregnancies in up to 25% of the couples. In case of failure sperm aspiration from the epididymis and intracytoplasmic sperm injection is the treatment of choice.