精索捻転症の術後造精機能

Abstract

精索捻転症の手術において, 患側精巣の固定術および摘除術の比較を行った。1)造精機能は固定群では正常化したが, 摘除群では術後2年以上経過してもその一部に20×106/ml未満の乏精子症および無精子症を認めた。2)FSHは固定群は術後経過とともに値が低下し正常化したが, 摘除群ではこのような傾向はみられず一部は高値のままであった。3)発症後早期の患側精巣固定術が造精機能の回復にとって重要であると思われた4)摘除群においても, 手術時思春期前であれば術後造精機能の障害は少ないと思われた

Semen quality and endocrine parameters after spermatic cord torsion were investigated. Of 24 patients evaluated following spermatic cord torsion 12 were treated with bilateral orchiopexy (orchiopexy group), and 12 were treated with ipsilateral orchiectomy and contralateral orchiopexy (orchiectomy group). The average sperm density and the average total sperm count in the orchiectomy group were significantly lower than those in the orchiopexy group (p < 0.05, p < 0.05, respectively). The mean serum follicle stimulating hormone level in the orchiectomy group was significantly higher than that in the orchiopexy group (p < 0.05). These findings suggest a significant decrease in testicular function in the orchiectomy group. All the patients in the orchiopexy group demonstrated a normal semen quality and endocrine parameters during followup. Four of the 8 patients in the orchiectomy group whose duration of followup was more than two years still demonstrated oligozoospermia (< 20 x 10(6)/ml, one of 4 was azoospermia). The average age at operation of these four patients with abnormal semen quality was significantly higher than that of the other 4 patients with normal semen quality (p < 0.05), whereas no significant difference in duration of torsion preceding surgical therapy was observed between these two groups. These findings suggest that subsequent semen quality is likely to remain within normal limits with early surgical treatment by bilateral orchiopexy. Ipsilateral orchiectomy in the younger generation seems to result in less damage of the contralateral testis than in the older generation.