Schuppe H-C, Pilatz A, Hossain H, Meinhardt A, Bergmann M, Haidl G, Weidner W
Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Giessen, Gaffkystrasse 14, 35385, Giessen, Deutschland.
Urologe A. 2010 May;49(5):629-35. doi: 10.1007/s00120-010-2256-1.
Infections and inflammations of the genital tract are considered the most frequent causes of reduced male fertility, but conclusive epidemiological data are not available. In view of the exposure of germ cells to pathogenic components as well as the cells and mediators involved in the inflammatory processes, irreversible damage to spermatogenesis and corresponding decline of ejaculate quality are to be expected, particularly in cases of chronic orchitis. While the consequences of orchitis and epididymo-orchitis that exhibit clinical symptoms due to systemic or local infections are well known, including testicular atrophy and complete loss of fertility, those cases of inflammatory reactions of the testicles that manifest an asymptomatic or subclinical course, or are not even due to an infection, have received little attention until now. However, systematic histopathological analyses have shown a high prevalence of asymptomatic inflammatory reactions in testicular biopsies from infertile men. The mostly focal lymphocytic infiltrates correlate with the degree of damage to spermatogenesis and corresponding clinical and endocrinological parameters of testicular function. Noninvasive diagnostic techniques are not yet available so that chronic asymptomatic inflammations of the testicles as the primary cause or cofactor of male fertility disorders are underestimated. Except for administration of pathogen-specific antibiotics, treatment recommendations are to a large extent still lacking.
生殖道感染和炎症被认为是男性生育力下降的最常见原因，但尚无确凿的流行病学数据。鉴于生殖细胞暴露于致病成分以及炎症过程中涉及的细胞和介质，预计精子发生会受到不可逆转的损害，射精质量也会相应下降，尤其是在慢性睾丸炎的情况下。虽然由于全身或局部感染而出现临床症状的睾丸炎和附睾炎的后果是众所周知的，包括睾丸萎缩和生育力完全丧失，但那些表现为无症状或亚临床病程、甚至并非由感染引起的睾丸炎症反应病例，至今很少受到关注。然而，系统的组织病理学分析表明，在不育男性的睾丸活检中，无症状炎症反应的发生率很高。大多数局灶性淋巴细胞浸润与精子发生的损伤程度以及睾丸功能相应的临床和内分泌参数相关。目前尚无无创诊断技术，因此作为男性生育障碍主要原因或辅助因素的慢性无症状睾丸炎症被低估了。除了使用针对病原体的抗生素外，在很大程度上仍然缺乏治疗建议。
