男性不妊の研究 第III篇: 精嚢腺X線像の観察

Abstract

Seminal vesiculograms of 124 males with infertility were m orphologically and endocrinologically observed with special reference to testicular biopsy finding, adrenocortical function, and semen analysis. Organic changes of the seminal vesicles were also investigated with relation to infertility. 1) Endocrinological significance of seminal vesiculograms. Seminal vesiculograms were classified a c cording to Ishigami-Mori's classification. They diveded vesiculograms into four groups. The first type (I) : An adult type with a large main duct and well-developed diverticula. The second type (II) Poor in the growth of the diverticula, while it has a l a rge main duct. The third type (III) : H a s well-developed diverticula but with a small main duct. The fourth type (IV) : Poor both in the growth of the diverticula and in the s ize of the main duct, An infantile shape. The age angle was postulated by author which is the angle formed between both main ducts of the seminal vesicles. It was classified as follows and its endocrinological observation was made. (+) under 85° (+1-) 8 5-115 ° (*) o ver 115° The results of each classifying were as follows. I 25.7% (+) 11.4% II ...57.2% (+1-) 6 1.0% III 11.4% (*) 2 7 . 6 % IV 5.7% In general, seminal vesiculog r ams in male infertility showed some senile changes. 2) Seminal vesiculograms and semen analysis. The average amount of semen wa s 3.2cc in type I, 2.5cc in II, 2.1cc in III, and 1.5cc in IV. This shows that the amount of semen is in proportion to the size of the seminal vesicles. Fructose in semen was 492mg/dI in type I, 465mg/dl in II, and 495mg/d1 in III, and 240mg/d1 in IV each in average. There was, therefore, no obvious relationship between fructose concentration and seminal vesicle morphology. Exceptionally, a few cases with severe hypoplasia of the seminal vesicles showed low fructose level. 3) Seminal vesiculograms and microscopic finding of testes. Testicular biopsy findings were studied according to Ishigami-Mori's classification (A : Only the seminiferous tubules are disturbed. B : The interstitial cells are selectively disturbed. C : Both the seminiferous tubules and the interstitial cells are disturbed. D Normal.) and a classification on spermatogenesis (Germ cell aplasia. Spermatogenic arrest. Peritubular or tubular fibrosis. Hypospermatogenesis. Normal.). Comparative studies were made on testicular histology and seminal vesiculograms. No obvious correlation was noted between them in male infertility, however, some cases with interstital cell insufficiency showed immature vesiculograms. 4) Seminal vesiculograms and adrenocortical function Screening tests for adrenocortical function were carried out by means of Thorn's test and urinary excretion of 17-ketosteroid. Their values were compaired with seminal vesiculograms seeking for any relationship. In vesiculograms of type III and IV, so-called insufficient types, many showed low or lowest normal level. It is uncertain, however, if this suggests direct relation between the adrenal cortex and seminal vesicles. 5) Morbid changes in the seminal vesicles and infertile factors . In 19 cases in which morbid changes in the seminal vesicles such as 12 cases of patholo gical dilatation of the vesicles and the end of vas, 2 cases of tuberculosis of the vesicle and 5 cases of hemospermia were considered as the causes of infertility , volume of semen, count and motility rate of sperm, and fructose content were examined . Although there were no noticeable changes in the volume and fr u ctose content of the semen, sperm count and motility showed variable defect in almost all the cases .