纯弱精子症治疗方式对精液参数改变的评价

Dr. Nafea Taha Salih, Dr. Gailan Adil Saeed
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Patients were divided in two groups: Surgical arm (71 patients with different grades of varicoceles) and the medical arm (47 patients with no overt clinical varicoceles). For all patients, a full assessment had been done, including at least two seminal fluid analyses as a baseline (to document the presence of pure Asthenospermia). Surgical arm patients were treated with subinguinal varicocelectomy, and medical arm patients were treated with oral supplementation of L-carnitine 1 gm/day. Patients in both groups were followed for 6-12 months by repeated seminal fluid analyses to check the changes in sperm motility. Adverse effects of the treatment were also checked during follow-up visits. Results and Discussion: Surgical arm patients included were 26,23, and 12 patients with varicocele grades 1,2, and 3, respectively, and ten patients with subclinical varicoceles. Medical arm patients included were 32 patients with no varicoceles and 15 patients with subclinical varicoceles. 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引用次数: 0

摘要

背景:弱精子症是不孕患者精液分析中最常见的发现之一。尽管进行了全面的诊断检查,但弱精子症的病因并不总是很清楚;因此,对于这种情况的最佳治疗方法存在很多争议。研究目的:通过观察精液参数的变化,评估纯弱精子症患者的两种治疗方式的有效性,一种是手术治疗(精索静脉曲张切除术),另一种是药物治疗(补充左旋肉碱)。患者和方法:一项前瞻性研究于2021年8月23日至2022年4月18日在AL-Yarmouk教学医院/泌尿外科进行。其中包括118名不育男性患者。患者分为两组:外科组(71例有不同程度精索静脉曲张的患者)和内科组(47例无明显临床精索静脉曲张的患者)。对所有患者都进行了全面评估,包括至少两次精液分析作为基线(以记录纯弱精子症的存在)。手术组患者行腹股沟下精索静脉曲张切除术,内科组患者口服左旋肉碱1 gm/天。两组患者随访6-12个月,反复进行精液分析,以检查精子活力的变化。在随访期间也检查了治疗的不良反应。结果和讨论:手术臂患者分别为1级、2级和3级精索静脉曲张患者26例、23例和12例,亚临床精索静脉曲张患者10例。医疗组纳入32例无精索静脉曲张患者和15例亚临床精索静脉曲张患者。精索静脉曲张切除术组治疗后精液参数(总精子运动状态)的变化有统计学意义,且精液参数的改善与精索静脉曲张的分级直接相关,而亚临床精索静脉曲张组无明显改善。在医疗方面,我们改善了精子活力状况,但没有统计学意义。结论:单纯弱精子症和临床发现精索静脉曲张的患者最好行精索静脉曲张切除术,且精索静脉曲张级别越多,效果越好。纯弱精子症患者补充左旋肉碱被证明是有益和安全的,但当单独给予时,它不足以将精子活力状态提高到正常值。
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Evaluation of Treatment Modalities for Pure Asthenospermia Regarding Changes in Seminal Fluid Parameters
Background: Asthenospermia is one of the most common findings in the seminal fluid analysis of patients with infertility. In spite of a full diagnostic workup, the causes of Asthenospermia are not always clear; accordingly, there are a lot of controversies about the best treatment for such a condition. Aim of the study: To evaluate the validity of two treatment modalities for patients with pure Asthenospermia, one surgical (varicocelectomy) and the other medical (L-carnitine supplementation), by following changes in seminal fluid parameters. Patients and methods: A prospective study was conducted at AL-Yarmouk Teaching Hospital/Urology Department from 23rd August 2021 to 18th April 2022. One hundred eighteen infertile male patients were included. Patients were divided in two groups: Surgical arm (71 patients with different grades of varicoceles) and the medical arm (47 patients with no overt clinical varicoceles). For all patients, a full assessment had been done, including at least two seminal fluid analyses as a baseline (to document the presence of pure Asthenospermia). Surgical arm patients were treated with subinguinal varicocelectomy, and medical arm patients were treated with oral supplementation of L-carnitine 1 gm/day. Patients in both groups were followed for 6-12 months by repeated seminal fluid analyses to check the changes in sperm motility. Adverse effects of the treatment were also checked during follow-up visits. Results and Discussion: Surgical arm patients included were 26,23, and 12 patients with varicocele grades 1,2, and 3, respectively, and ten patients with subclinical varicoceles. Medical arm patients included were 32 patients with no varicoceles and 15 patients with subclinical varicoceles. Changes in seminal fluid parameters (total Sperms motility status) after treatment were statistically significant in the varicocelectomy group, and improvement in the seminal fluid parameters was directly related to the grade of the varicoceles with no significant improvement in the patients with subclinical varicoceles. In the medical arm, we achieved an improvement in sperm motility status, but it was not statistically significant. Conclusion: Patients with pure Asthenospermia and clinically detected varicoceles are best treated by varicocelectomy, and the more grade varicoceles, the better results are achieved. L-carnitine supplementation for patients with pure Asthenospermia proved to be beneficial and safe, but when given alone, it was not enough to raise sperm motility status to normal values.
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