Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH - Site Gießen, Justus-Liebig University, Gießen, Germany; Institute of Medical Microbiology, Universitätsklinikum Gießen und Marburg GmbH - Site Gießen, Justus-Liebig University, Gießen, Germany.
Dtsch Arztebl Int. 2017 May 12;114(19):339-346. doi: 10.3238/arztebl.2017.0339.
Infections of the genital tract are considered common causes of male fertility disorders, with a prevalence of 6-10%. Most of the affected men are asymptomatic. The diagnostic evaluation is based mainly on laboratory testing. Inconsistent diagnostic criteria have been applied to date, and this may explain the controversial debate about the role of infection and inflammation in the genital tract as a cause of infertility. The risk of an irreversible fertility disorder should not be underestimated.
This review is based on pertinent publications retrieved by a selective literature search in PubMed, including guidelines from Germany and abroad and systematic review articles.
The main causes of inflammatory disease of the male genital tract are ascending sexually transmitted infections (STIs) and uropathogens. Chronic prostatitis has no more than a limited influence on ejaculate variables. By contrast, approximately 10% of men who have had acute epididymitis develop persistent azoospermia thereafter, and 30% have oligozoospermia. Obstruction of the excurrent ducts can ensue, as can post-infectious disturbances of spermatogenesis. The differential diagnostic evaluation includes the determination of testicular volumes, hormone concentrations, and ejaculate variables. Epidemiological data are lacking with regard to infertility after primary orchitis of infectious origin; however, up to 25% of testicular biopsies obtained from infertile men reveal focal inflammatory reactions. Multiple studies have suggested a deleterious effect of leukocytes and inflammatory mediators on sperm para - meters. On the other hand, the clinical significance of bacteriospermia remains unclear.
Any suspicion of an infectious or inflammatory disease in the male genital tract should prompt a systematic diagnostic evaluation and appropriate treatment. For patients with obstructive azoospermia, the etiology and site of the obstruction determine the surgical approach to be taken. In the near future, the elucidation of underlying pathophysiological mechanisms and the identification of suitable biomarkers may enable new strategies for conservative treatment.
生殖道感染被认为是男性生育障碍的常见原因,患病率为 6-10%。大多数受影响的男性无症状。诊断评估主要基于实验室检测。迄今为止,应用的诊断标准不一致,这可能解释了生殖道感染和炎症作为不孕原因的争议性辩论。不应低估不可逆生育障碍的风险。
本综述基于在 PubMed 中进行的选择性文献检索中检索到的相关出版物,包括德国和国外的指南以及系统评价文章。
男性生殖道炎症性疾病的主要原因是上行性性传播感染(STI)和尿路病原体。慢性前列腺炎对精液变量的影响有限。相比之下,大约 10%的急性附睾炎患者此后会发展为持续性无精子症,30%的患者为少精子症。可能会发生输出管阻塞,也可能会发生感染后精子发生障碍。鉴别诊断评估包括睾丸体积、激素浓度和精液变量的测定。原发性感染性睾丸炎后不育的流行病学数据缺乏,但在不育男性中,多达 25%的睾丸活检显示局灶性炎症反应。多项研究表明白细胞和炎症介质对精子参数有有害影响。另一方面,细菌性精子症的临床意义仍不清楚。
任何对男性生殖道感染或炎症性疾病的怀疑都应促使进行系统的诊断评估和适当的治疗。对于梗阻性无精子症患者,梗阻的病因和部位决定了所采取的手术方法。在不久的将来,阐明潜在的病理生理机制和确定合适的生物标志物可能为保守治疗提供新策略。