UrologiiaUrologiiaУрология1728-29852414-9020Bionika Media280403ArticlesСтатьиResearch ArticleREPRODUCTIVE FUNCTION IN MEN WITH CHRONIC PROSTATITIS: CLINICAL, DISEASE HISTORY AND MICROBIOLOGICAL RISK ASPECTSРЕПРОДУКТИВНАЯ ФУНКЦИЯ МУЖЧИН ПРИ ХРОНИЧЕСКОМ ПРОСТАТИТЕ: КЛИНИКО-АНАМНЕСТИЧЕСКИЕ И МИКРОБИОЛОГИЧЕСКИЕ АСПЕКТЫBozhedomovV. A.БожедомовВ. А.

Department of Clinical Andrology; Prof, of Department of Obstetrics, Gynecology, Perinatology and Reproductive; Ph.D., Scientific Director of Andrology and Reproduction

каф. клинической андрологии; проф. каф. акушерства, гинекологии, перинатологии и репродуктологии; д.м.н., науч. рук. по андрологии и репродукции

vbojedomov@maiI.ruSemenovA. V.СеменовА. В.KonyshevA. V.КонышевА. В.LipatovaN. A.ЛипатоваН. А.PacanovskayaG. M.ПацановскаяГ. М.BozhedomovaG. E.БожедомоваГ. Е.Tret'yakovA. V.ТретьяковА. В.SBEI HPE «The Peoples' Friendship University of Russia»ГБОУ ВПО «Российский университет дружбы народов»SBEI HPE «First MSMU n.a. I.M. Sechenov»ГБОУ ВПО «Первый МГМУ им. И. М. Сеченова»FSBI «Polyclinic № 1of» of ABP of RFФГБУ «Поликлиника № 1» УДП РФSBIH «Regional Clinical Hospital» Healthcare Department of Ivanov cityГБУЗ «Областная клиническая больница» Департамента здравоохранения города ИвановаSBIH «City Polyclinic № 3» of Moscow Healthcare DepartmentГБУЗ «Городская поликлиника № 3 Департамента здравоохранения города Москвы150220151NO1 (2015)№1 (2015)707825022023Copyright ©; 2015, Bionika MediaCopyright ©; 2015, ООО «Бионика Медиа»2015Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/1728-2985/article/view/280403

Case records of 3174 men aged 20-45 years living in a heterosexual marriage and having a regular sexual life were analyzed. Examination of couples and sperm analysis was conducted in accordance with the requirements of the WHO. Leukocytospermia was present in 19% of infertile cases. In 54% of those cases chronic prostatitis was associated with aerobic bacterial infection, in 9% - with chlamydial and in 12% with urea- and mycoplasma. It was found that concentrations of leukocytes in semen and clinical symptoms (pain and dysuria) were not independent risk factors for infertility. Infertile patients had higher incident rates of E. coli (OR=4,1) and bacterial associations (OR=6,9) with reduced antimicrobial resistance of seminal plasma(for E. coli OR=9,9; for Ps. aeruginosa OR=6,0). Other risk factors for fertility reduction in patients with HP are the duration of the disease (OR=2,7), frequency of exacerbations (OR=2,6), presence of fibrosis and prostatolites (OR=1,8) and functional prostate-vesicular obstruction (OR=1,4). Further studies are needed to understand HP pathogenesis and explain the negative impact of HP on male fertility.

Взаимосвязь между хроническим простатитом (ХП) и нарушением фертильности остается спорным вопросом. Целью исследования было изучить клинико-анамнестические и микробиологические факторы риска снижения фертильности у мужчин с ХП. Исследование было многоцентровым одномоментным ретроспективным. Проанализированы медицинские карты и компьютерные истории болезни 3174мужчин в возрасте от 20до 45 лет, состоявших в гетеросексуальных брачных отношениях и живших регулярной половой жизнью. Обследование пары и исследование спермы проведены в соответствии с требованиями ВОЗ. Лейкоцитоспермия имела место у 19% мужчин из бесплодных пар. Хронический простатит при этом в 54% случаев ассоциировался с аэробной бактериальной инфекцией, в 9% - с хламидийной, в 12% - с уреа- и микоплазменной. Установлено, что концентрация спермальных лейкоцитов и выраженность клинических симптомов (боль и дизурия) не являются независимыми факторами риска развития бесплодия. Для бесплодных характерно увеличение частоты встречаемости E. coli (ОШ=4,1) и появление бактериальных ассоциаций (ОШ=6,9) на фоне снижения антибактериальной резистентности спермальной плазмы (для E. coli ОШ=9,9; для Ps. aeruginosa ОШ=6,0). Факторами риска снижения фертильности при ХП также являются продолжительность анамнеза (ОШ=2,7) и частота обострений (ОШ=2,6), наличие фиброза и простатолитов (ОШ=1,8), функциональная обструкция простатовезикулярного комплекса (ОШ=1,4). Необходимы дальнейшие исследования для понимания патогенеза простатита и объяснения негативного влияния простатита на мужскую фертильность.

chronic prostatitisinfertilitysemenleukocytospermiaхронический простатитбесплодиеспермалейкоцитоспермияFaasse M.A., Niederberger C.S. Epidemiological consideration in male infertility. In: Male infertility. S.J. Parekattil, A. Agarwal, eds. Springer, 2012. P. 131-142.Sigman M., Jarow J.P. Male infertility. In.: Campbell-Walsh urology, 9th ad. Wein A.J., Kavoussi L.R. et al., eds. Philadelphia: Saunders Elsevier, 2007. P. 609-653.Greenhall E., Vessey M. The prevalence of subfertility: a review of the current confusion and a report of two new studies. Fertil. Steril. 1990;54:978-983.WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. Cambridge: Cambridge University Press, 2000. 91 p.Guidelines on Male Infertility. A. Jungwirth, T. Diemer, G.R. Dohle et al., eds. European Association of Urology, 2013. 60 p.Сухих Г.Т., Божедомов В.А. Мужское бесплодие. Практическое руководство для урологов и гинекологов. М.: Эксмо, 2009. 240 с.Weidner W, Krause W., Ludwig M. Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis. Hum. Reprod. Update. 1999;5(5):421-432.Fu W., Zhou Z., Liu S., Li Q., Yao J., Li W., Yan J. The effect of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) on semen parameters in human males: a systematic review and metaanalysis. PLoS One. 2014;9(4):e94991.Kasturi S.S., Osterberg C., Tannir J. et al. The effect of genital tract infection and inflammation on male. In: Infertility in the male. Fourth ed. L.I. Lipshults, S.S. Howards, C.S. Niederberger, eds. 2009. P. 331-361.Henkel R. Infection in infertility. In: Male infertility. S.J. Parekattil, A. Agarwal, eds. Springer, 2012. P. 261-272.Wolff H., Politch J.A., Martinez A. Haimovici F., Hill J.A., Anderson D.J. Leukocytospermia is associated with poor semen quality. Fertil. Steril. 1990;53:528-536.Gonzales G.F., Kortebani G., Mazzolli A.B. Leukocytospermia and function of the seminal vesicles on seminal quality. Fertil Steril. 1992;57:1058-1065.Arata de Bellabarba G., Tortolero I., Villarroel V., Villarroel V., Molina C.Z., Bellabarba C., Velazquez E. Nonsperm cells in human semen and their relationship with semen parameters. Arch Androl. 2000;45:131-136.Domes T., Lo K.C., Grober E.D., Mullen J.B.,, Mazzulli T., Jarvi K. The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters. Fertil, Steril. 2012;97(5):1050- 1055.La Vignera S., Vicari E., Condorell R.A., D’Agata R., Calogero A.E. Male accessory gland infection and sperm parameters (review). Int. J. Androl. 2011;34:e330-e347.Евдокимов В.В.,Ерасова В.И., Орлова Е.В., Демин А.И., Марчук Н.В. Репродуктивная функция у больных хроническим абактериальным простатитом. Урология. 2006;2:68-69.Неймарк А.И., Алиев Р.Т. Значение исследования энзимов спермальной плазмы в патогенезе относительного мужского бесплодия. Урология. 2000;3:34-37.Armstrong J.S., Rajasekaran M., Chamulitrat W., Gatti P., Hellst- rom W.J., Sikka S.C. Characterization of reactive oxygen species induce defects on human spermatozoa movement and energy metabolism. Free Radic. Biol. Med. 1999;26:869-880.Божедомов В.А., Ушакова И.В., Торопцева М.В., Александрова Л.А., Сухих Г.Т., Теодорович О.В., Громенко Д.С., Галимов Ш.И. Оксидативный стресс сперматозоидов в патогенезе мужского бесплодия. Урология. 2009;2:51 -56.Kullisaar T., Turk S., Punab M., Mandar R. Oxidative stress - cause or consequence of male genital tract disorders? Prostate. 2012;72:977-983.Villegas J., Kehr K., Soto L., Henkel R., Miska W., Sanchez R. Reactive oxygen species induce reversible capacitation in human spermatozoa. Andrologia. 2003;35 (4):227-232.Diemer T., Huwe P., Michelmann H.W., Mayer F., Schiefer H.G., Weidner W. Escherichia coli-induced alterations of human spermatozoa. An electron microscopy analysis. Int. J. Androl. 2000;23:178-186.Everaert K., Mahmoud A., Depuydt C., Maeyaert M., Comhaire F. Chronic prostatitis and male accessory gland infection - is there an impact on male infertility (diagnosis and therapy)? Andrologia. 2003;35 (5):325-330.Schulz M., Sanchez R., Soto L., Risopatron J., Villegas J. Effect of Escherichia coli and its soluble factors on mitochondrial membraneepotential, phosphatidylserine translocation, viability, and motility of human spermatozoa. Fertil. Steril. 2010;94:619-623.Tomlinson M.J., Barratt C.L., Cooke I.D. Prospective study of leukocytes and leukocyte subpopulations in semen suggests they are not a cause of male infertility. Fertil Steril 1993;60:1069-1075.Pasqualotto F.F., Sharma R.K., Potts J.M., Nelson D.R., Thomas A.J., Agarwal A. Seminal oxidative stress in patients with chronic prostatitis. Urology. 2000;55(6):881-885.Ludwig M., Vidal A., Huwe P., Diemer T., Pabst W., Weidner W. Significance of inflammation on standard semen analysis in chronicprostatitis/chronic pelvic pain syndrome. Andrologia. 2003;35:152-156.Aitken R.J., Baker M.A. Oxidative stress, spermatozoa and leukocytic infiltration:relationships forged by the opposing forces of microbial invasion and the search for perfection. J. Reprod. Immunol. 2013;100(1):11-19.WHO laboratory manual for the examination and processing of human semen. WHO, 2010. 271 p.Сидоренко С.В. Колупаев В.Е. Антибиотикограмма: дискодиффузионный метод. Интерпретация результатов. M., 1998. 32 с.Aitken R.J., Curry B.J. Redox regulation of human sperm function:from the physiological control of sperm capacitation to the etiology of infertility and DNA damage in the germ line. Antioxid. Redox. Signal. 2011;14:367-381.Kaleli S., Ocer F., Irez T., Budak E., Aksu M.F. Does leukocytospermia associate with poor semen parameters and sperm functions in male infertility? The role of different seminal leukocyte concentrations. Eur. J. Obstet. Gynecol. Reprod. Biol. 2000;89:185-191.Henkel R., Maab G., Jung A., Haidl G., Schill W.B., Schuppe H.C. Age-related changes in seminal polymorphonuclear elastase in men with asymptomatic inflammation of the genital tract. Asian J. Androl. 2007;9:299-304.Leib Z, Bartoov B, Eltes F, Servadio C. Reduced semen quality caused by chronic abacterial prostatitis:an enigma or reality? Fertil. Steril. 1994;61(6):1109-1116.Menkveld R., Huwe P, Ludwig M, Weidner W.Morphological sperm alternations in different types of prostatitis. Andrologia. 2003;35(5):288-293.Lotti F., Corona G., Mondaini N., Maseroli E., Rossi M., Filimberti E., Noci I., Forti G., Maggi M. Seminal, clinical and colour-Doppler ultrasound correlations of prostatitis-like symptoms in males of infertile couples. Andrology. 2014;2(1):30-41.Alshahrani S., McGill J., Agarwal A. Prostatitis and male infertility. J. Reprod. Immunol. 2013;100(1):30-36.Eley A., Hosseinzadeh S., Hakimi H., Geary I., Pacey A.A. Apoptosisof ejaculated human sperm is induced by co-incubation with Chlamydia trachomatis lipopolysaccharide. Hum. Reprod. 2005;20:2601-2607.Fujita Y., Mihara T., Okazaki T., Shitanaka M., Kushino R., Ikeda C., Negishi H., Liu Z., Richards J.S., Shimada M. Toll-like receptors (TLR) 2 and 4 on human sperm recognize bacterial endotoxinsand mediate apoptosis. Hum. Reprod. 2011;26:799-806.Fraczek M., Piasecka, M., Gaczarzewicz D., Szumala-Kakol A., Kazienko A., Lenart S., Laszczynska M., Kurpisz M. Membrane stabilityand mitochondrial activity of human-ejaculated spermatozoa duringin vitro experimental infection with Escherichia coli, Staphylococcus haemolyticus and Bacteroides ureolyticus. Andrologia. 2012;44:315-329.Fraczek M., Szumala-Kakol, A., Jedrzejczak, P., Kamieniczna M., Kurpisz M. Bacteria trigger oxygen radical release and sperm lipid peroxidation in in vitro model of semen inflammation. Fertil. Steril. 2007;88(4):1076-1085.Cunningham K.A., Beagley K.W. Male genital tract chlamydial infection: implications for pathology and infertility. Biol. Reprod. 2008;79:180-189.Ouzounova-Raykova V., Ouzounova I., Mitov I.G. Chlamydia trachomatis be an aetiological agent of chronic prostatic infection? Andrologia. 2010;42:176-181.Kalwij S., French S., Mugezi R., Baraitser P. Using educational outreach and a financial incentive to increase general practices’ contribution to chlamydia screening in South-East London 20032011. BMC Public Health, 2012;12. 802 p.Motrich R.D., Cuffini C., Oberti J.P., Maccioni M., Rivero V.E. Chlamydia trachomatis occurrence and its impact on sperm quality in chronic prostatitis patients. J. Infect. 2006;53:175-183.Mackern-Oberti J.P., Motrich R.D., Breser M.L., Sanchez L.R., Cuffini C., Rivero V.E. Chlamydia trachomatis infection of the male genital tract:an update. J. Reprod. Immunol. 2013;100(1):37-53.Weidner W., Diemer T., Huwe P., Rainer H., Ludwig M. The role of Chlamydia trachomatis in prostatitis. Int. J. Antimicrob. Agents. 2002;19:466-470.Mazzoli S., Cai T., Addonisio P., Bechi A., Mondaini N., Bartoletti R. Chlamydia trachomatis infection is related to poor semen quality in young prostatitis patients. Eur. Urol. 2010;57: 708-714.Pajovic B., Radojevic N., Vukovic M., Stjepcevic A. Semen analysis before and after antibiotic treatment of asymptomatic Chlamydia- and ureaplasma-related pyospermia. Andrologia. 2012;44:18-28.Weidner W., Ludwig M., Thiele D., Thiele D., Ludwig M. Chlamydial antibodies in semen: Search for «silent» chlamydial infections in asymptomatic andrological patients. Infection. 1996;24:309-313.Eggert-Kruse W.,Rohr G., Kunt B., Meyer A., Wondra J., Strowitzki T., Petzoldt D. Prevalence of Chlamydia trachomatis in subfertile couples. Fertil. Steril. 2003;80:660-663.de Barbeyrac B., Papaxanthos-Roche A., Mathieu C., Germain C., Brun J.L., Gachet M., Mayer G., Bebear C., Chene G., Hocke C. Chlamydia trachomatis in subfertile couples undergoing an in vitro fertilization program:a prospective study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2006;129:46-53.Gdoura R., Kchaou W., Chaari C., Znazen A., Keskes L., Rebai T., Hammami A. Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis and Mycoplasma genitalium infections and semen quality of infertile men. BMC Infect. Dis. 2007;7:129.Hosseinzadeh S., Pacey A.A., Eley A. Chlamydia trachomatis- induced death of human spermatozoa is caused primarily by lipopolysaccharide. J. Med. Microbiol. 2003;52:193-200.Radonic A., Kovacevic V., Markotic A., Skerk V., Turcic P., Skerk V. The clinical significance of Ureaplasma urealyticum in chronic prostatitis. J Chemother. 2009;21(4):465-466.Nickel J.C. Chronic prostatitis: Current concepts and antimicrobial chemotherapy. Infect. Urol. 2000;13(5):22-28.La Vignera S., Condorelli R.A., Vicari E., D’Aagata R., Salemi M., Calogero A.E. Hyperviscosity of semen in patients with male accessorygland infection:direct measurement with quantitative viscosimeter. Andrologia. 2012;44:556-559.Elia J., Delfino M., Imbrogno N., Capogreco F., Lucarelli M., Rossi T., Mazzilli F. Human semen hyperviscosity:prevalence, pathogenesisand therapeutic aspects. Asian J. Androl. 2009; 11:609-615.Gonzales G.F., Villena A. True corrected seminal fructose level:a better marker of the function of seminal vesicles in infertile men. Int. J. Androl., 2001;24(5):255-260.Zhang X.D., Jin B.F. The role ofseminal vesicles in male reproduction and sexual function. Zhonghua Nan Ke Xue. 2007;13(12):1113- 1116.Sperm chromatin:biological and clinical application in male infertility and assisted reproduction. A. Zini, A. Agarwal, eds. Springer, 2011. 512 p