Brunner Robert J, Demeter Jonathan H, Sindhwani Puneet
College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA.
Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA.
World J Mens Health. 2019 May;37(2):128-137. doi: 10.5534/wjmh.180078. Epub 2018 Dec 31.
Leukocytospermia is an ill-defined and poorly understood condition affecting up to 30% of male factor infertility. Current guidelines on leukocytospermia vary significantly, although it has been linked to increased rates of infertility, uncertainty about its clinical significance, diagnosis, and treatment remains. The guidelines are conflicting with sparse data scattered across different specialties and continents. This study aims to compare and contrast available international guidelines and recommendations. In addition to these guidelines, we sought to consolidate the findings of trials over the last several decades. English language articles on human observational studies, retrospective, prospective, clinical trials and randomized control trials were searched for using the following terms: "leukocytospermia, pyospermia, and male infertility." Articles about treatment and management of leukocytospermia that were published between January 2010 and April 2018 were included, as well as four articles referenced in best practice and guideline statements from urological and andrological associations. Disagreements on this topic are highlighted as some guidelines describe no correlation between leukocytospermia and infertility while others show that treatment leads to improvement of sperm quality by many measures including improved pregnancy rate. Various treatments have been suggested including antibiotics, anti-inflammatory medications, and frequent ejaculation. There is a need for definitive characterization of Leukocytospermia as an infectious or inflammatory marker and a re-evaluation of the leukocyte concentration threshold. Additional studies investigating rates of conception as a measure of outcome are needed, to provide greater level of evidence and generalizability of leukocytopsermia management.
白细胞精子症是一种定义不明确且了解甚少的病症，影响着高达30%的男性因素不孕症。目前关于白细胞精子症的指南差异很大，尽管它与不孕率增加有关，但其临床意义、诊断和治疗仍存在不确定性。这些指南相互冲突，且不同专业和各大洲的数据稀少。本研究旨在比较和对比现有的国际指南和建议。除了这些指南，我们还试图汇总过去几十年的试验结果。使用以下术语搜索了关于人类观察性研究、回顾性、前瞻性、临床试验和随机对照试验的英文文章：“白细胞精子症、脓性精液症和男性不育症”。纳入了2010年1月至2018年4月发表的关于白细胞精子症治疗和管理的文章，以及泌尿外科学会和男科学会最佳实践和指南声明中引用的四篇文章。关于这个主题的分歧很突出，因为一些指南描述白细胞精子症与不育症之间没有关联，而另一些指南则表明治疗可通过包括提高妊娠率在内的多种措施改善精子质量。已经提出了各种治疗方法，包括抗生素、抗炎药物和频繁射精。需要将白细胞精子症明确表征为一种感染或炎症标志物，并重新评估白细胞浓度阈值。还需要进行更多研究，以受孕率作为结果指标进行调查，为白细胞精子症的管理提供更高水平的证据和可推广性。
