RU2205040C2 - Method for treating secretory forms of masculine infertility - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering 8-12 infusions of rheopolyglukine mixed with Oxycelodex and Thrombovar or Curantyl. The lower epigastric artery is embolized with thrombin solution mixed with Oxycelodex or Thrombovar under finger-constricted initial area of inferior epigastric artery. EFFECT: enhanced effectiveness of sexual gland revascularization.

Description

 The invention relates to medicine, in particular to andrology, and may find application in the treatment of secretory forms of male infertility. There is a method of treating secretory (parenchymal) infertility by indirect revascularization of the testicles, which consists in exposure and ligation of the lower epigastric artery above the place where the cremaster artery leaves it (Lesin A.I. Anatomical and clinical observations of the possibility of revascularization in the genital area of men. In the book. Issues of collateral blood circulation in functional anatomical and clinical lighting. - Ivano-Frankivsk, 1964, p.29).

 The disadvantage of this method is the low clinical efficacy. The objective of the invention is a method that improves the effectiveness of the method of treatment of secretory male infertility.

 This problem is solved by the method consisting in the fact that they conduct 8-12 drug infusions of solutions into the pool of the cremasteric artery through a chronic catheter installed in the lower epigastric artery above the mouth of the cremasteric artery, and then embolize the distal section of the lower epigastric artery above the place of discharge of the cremasternal arteries with digital compression of the initial part of the lower epigastric artery.

 In practice, the method is carried out using medicinal infusions of 400 ml of reopoliglukin in a mixture with 5 ml of a 2% solution of trental or 2-4 ml of a 0.5% solution of chimes.

 The following examples illustrate the method.

 Example 1. Ms. B-in K., 24 years old, was admitted to the hospital on May 8, 1987. Clinical diagnosis: infertility. Condition after releasing the right testicle into the scrotum and orchidopexy due to inguinal retension. Hypoplasia of the testicles and appendages. Oligospermia III art.

 Anamnesis of the disease: due to the fact that since childhood the right testicle was absent in the scrotum, at the age of 12, an operation was performed to revise the inguinal region, lower the testicle into the scrotum, and orchidopexy on the right. At the same age suffered mumps. At the age of 20, he underwent two comprehensive courses of treatment for chronic prostatitis, and subsequently with persistent remission.

 Real marriage first. For 5 years, the wife does not become pregnant, is gynecologically examined and recognized as healthy. He first turned to the andrologist in 1983 and for 3 years he was treated with hormones (chorionic gonadotropin, androgens) and vitamins (tocopherol acetate, group B) for diagnosed secretory infertility. However, treatment did not have a result, persistent oligozoospermia of the III degree remained.

 Andrological status: there are no clinical signs of androgen deficiency. The state of sexual function is normal. The penis is normal in size, no deformities.

 Testicles in the scrotum: right - with dimensions of 1.5 • 1.0 • 1.0 cm, volume 2.9 ml, flabby consistency, its appendage is sharply hypoplastic. The left testicle - dimensions 3.0 • 2.0 • 1.0 cm, volume 7 ml, flabby consistency, its appendage is moderately hypoplastic. Spermatic cord not changed. The vas deferens are clearly palpated, the right is hypoplastic. The prostate gland is normal in size, has a tight-elastic consistency, symmetrical, painless. The interlobar sulcus is moderately expressed.

 Cooper's seminal vesicles and glands are not palpable, their areas are painless.

 In secret prostate: white blood cells 2-4 p. Sp., Red blood cells and bacteria are absent, lecithin grains - all p. Sp.

 Back sowing of ejaculate and prostate secretion - no growth was noted.

 Immunological studies: PCA and RSI are negative. SIP = 1.3.

 May 15, 1987 under epidural anesthesia introduced a chronic catheter into the left lower epigastric artery above the mouth of the cremasteric artery.

 Starting from day 3, through this catheter, 8 infusions of a mixture of 400 ml of reopoliglyukin with 5 ml of a 2% trental solution were infused into the pool of the crem artery artery; the infusion rate was 40 drops per minute. Then, by introducing a solution of thrombin in a mixture with oxycelodex, the distal lower epigastric artery was embolized above the place where the cremaster artery left it. On day 9, the wound healed by first intention, the sutures were removed, the catheter was removed on day 12 without complications, was discharged from the hospital in satisfactory condition. Noteworthy is an increase in the volume of the left testicle by 6 ml (from 7 to 13 ml), which stably persists throughout the observation period.

 In the spermogram from 08.20.87: density - 38 million per 1 ml, actively mobile - 66%, morphologically unchanged - 76%. During this period, the wife became pregnant. Pregnancy was uneventful. May 9, 1988 urgent delivery, without complications. A full-term girl was born, weight 3100 g, height 58 cm. It grows and develops normally.

 At the repeated examination of March 17, 89: the volume of the left testicle is 13 ml. In the spermogram: density - 43 million in 1 ml, actively mobile - 65%, morphologically unchanged - 69%.

 In May 1990, the wife had a second pregnancy, performed a medical abortion.

 Example 2. Mr. S., 30 years old, was admitted to the clinical center of andrology and transplantation of endocrine organs on October 10, 1983.

 Clinical diagnosis: idiopathic infertility. Aspermia. Anamnesis of the disease: at the age of 19, he had a right-sided inguinal hernia repair. In 1975 - conservative therapy for right-sided acute orthoepididymitis.

 First turned to the andrologist in 1978. For 4 years he was treated with injections of lidase, chorionic gonadotropin, testosterone preparations, inside - with tocopherol acetate, speman-forte. In 1982, an operation was performed: isolation of the right vas deferens from adhesions, removal of lipomas of the right spermatic cord, bilateral examination of the scrotum organs. According to the results of histological studies of the tissue of both testicles (1844, 1769), pronounced dystrophy of spermatogenic epithelium, hypospermatogenesis of the II degree were revealed. Despite the ongoing complex therapy, it was not possible to achieve positive results, persistent aspermia remained.

 Andrological status: there are no signs of androgen deficiency. The state of sexual function is satisfactory. The penis is normal in size, no deformities.

 Testicles in the scrotum: right - with sizes 5.0 • 3.0 • 2.5 cm, 24 ml in volume, with a tight-elastic consistency, its appendage has not been changed. The left testicle is 4.0 • 2.5 • 2.0 cm in size, 13 ml in volume, of elastic consistency; its appendage has not been changed. Spermatic cord not expanded. The vas deferens are clearly palpated, not changed. The prostate gland is normal in size, has a tight-elastic consistency, symmetrical, painless. The interlobar sulcus is well defined.

 Cooper's seminal vesicles and glands are not palpable, their areas are painless.

 In secret prostate: white blood cells 5-6 p.z., red blood cells and bacteria are absent, lecithin grains - a moderate amount. Baksev ejaculate and prostate secretion did not give growth.

 Immunological studies: PCA and RSI are negative. SIP = 1.3. On November 17, 1983, a chronic catheter was inserted under epidural anesthesia into the left lower epigastric artery above the mouth of the cremaster artery (arterial fistula was formed). From the 4th day after the operation, 12 infusions of 400 ml of reopoliglyukin in a mixture with 4 ml of a 0.5% solution of chimeric at a rate of 40-50 drops per minute were performed through this catheter into the pool of the cremaster artery. Then, by introducing a solution of thrombin in a mixture with thrombovar, the distal lower epigastric artery was embolized above the place where the cremaster artery left it. The wound healed by first intention, the sutures were removed on the 10th day. The vascular fistula was removed on day 20 without complications. December 19, 1983 the patient was discharged from the hospital in satisfactory condition. There was an increase in the left testicle in a volume of 4 ml (from 13 to 17 ml), stably maintained throughout the observation period.

 In the spermogram from 05/12/84, the density is 6 million per 1 ml, the mobile ones are not, the morphologically unchanged ones are units.

 In the spermogram from 05.24.85: density - 12 million per 1 ml, mobile - 96%, morphologically unchanged - 29%. In the spermogram from 05.20.86: density - 18 million in 1 ml, mobile - 54%, morphologically unchanged - 72%. In January 1987, the wife had a pregnancy, which ended in a miscarriage (according to the conclusion of the gynecologists due to taking medications). In May 1987, a second pregnancy, which was uneventful. On February 1, 1988, a healthy full-term girl was born, weight 3100 g, height 50 cm. The child grows and develops normally. When re-examined 04.10.89, there is a stable increase in the volume of the left testicle compared with the initial volume before treatment by 4 ml (from 13 to 17 ml). In the spermogram: density - 27 million in 1 ml, actively mobile - 61%, morphologically unchanged - 67%.

 The described method has been treated 40 patients. Positive spermological effect (persistent improvement of spermogram parameters) was noted in 93% of patients. In 8 cases, the wives of the patients experienced pregnancies ending in 6 cases with the birth of healthy and full-term children.

Claims (1)

 A method of treating secretory forms of male infertility, including occlusion of the lower epigastric artery, characterized in that 8-12 infusions of reopoliglyukin in a mixture with solutions of trental or chimetry are first passed through a chronic catheter in the lower epigastric artery, and then the lower epigastric artery is embolized with a thrombin solution in a mixture with oxycelodex or thrombovar with finger clamping of the initial part of the lower epigastric artery.