Purpose - to determine significant sonographic pathogenetic markers of infertility formation in left-sided varicocele of II-III grades and their dynamics after laparoscopic varicocelectomy in the context of fertility restoration. Materials and methods. In the study, 214 patients with left-sided varicocele II-III grades and 25 practically healthy men aged 19 to 33 years were examined. All patients underwent laparoscopic varicocelectomy. The testes volume, the resistance index in the intratesticular arteries, and the diameter of the varicose veins of the left spermatic cord at rest in a horizontal position on the back with the head raised by 15° and during the Valsalva maneuver in a vertical position. During Valsalva maneuver also determined the duration and rate of venous blood reflux in the testes. Results. Ultrasound in patients with left varicocele II-III grades confirmed deterioration of hemodynamics in the spermatic cord and testis. According to the results of sonography in patients with left varicocele II-III grades identified significant prognostic markers of testicular lesions: RI>0.66, VD>2.4 mm, VDvm>3 mm, VRFvm>2 cm/s, and DVR>1.1 s. The negative dynamics of these indicators are an indication for the correction of varicocele, and their normalization in the postoperative period indicates the effectiveness of treatment. Conclusions. Testicular ultrasound is more informative than palpation. In patients of reproductive age with left-sided varicocele II-III grades sonography diagnoses testicular tissue damage in the early stages of the disease. It should be used as a non-invasive screening method for a comprehensive examination to determine testicular lesions and for monitoring in the context of fertility prognosis after varicocelectomy. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: varicocele, laparoscopic varicocelectomy, ultrasound examination, testicles.
Purpose - to substantiate the expediency of simultaneous minimally invasive interventions in children with urolithiasis. Materials and methods. The clinical material covers 7 children aged 5 to 14 years with stones in any part of the pelvicalyceal system and in the lower cystoid of the ipsilateral ureter without congenital anomalies of the urinary tract, which cause urodynamic disorders. In this patients group, the total stones size of the hollow renal system in the longest projection was more than 8 mm and in the lower third of the ureter 5-7 mm, and the stones density - from 750 HU (Hounsfield Units) and above. Results. In patients with urolithiasis, it is necessary to restore urodynamics as quickly as possible, removing all stones from the urinary tract, regardless of their number and location. This is especially important in children, because in this age group the kidney can develop and function only in favorable anatomical and physiological conditions. The problem is exacerbated by the combined stones location in different topical urinary tract areas, in particular, in the ureter and the pelvicalyceal system of the kidney. Simultaneous minimally invasive interventions with the use of contact lithotripsy - percutaneous nephrolithotripsy and ureteroscopy are the most optimal for its solution. Conclusions. Minimally invasive technologies in the treatment of urolithiasis in children are quite safe and allow to perform simultaneous surgery with the contemporaneous removal of all stones from various organs of the urinary system. Preventive drainage of the pelvicalyceal system with a JJ-stent minimizes the clinic of renal colic and creates positive conditions for ureteroscopy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the listed institution. Informed consent of children and their parents was obtained for the research. No conflict of interests was declared by the authors. Keywords: urolithiasis, ureteroscopy, percutaneous nephrolithotripsy, contact lithotripsy, calculus, children.
Hyperproduction of reactive oxygen species can damage sperm cells and is considered to be one of the mechanisms of male infertility. Cell protection from the damaging effects of free radicals and lipid peroxidation products is generally determined by the degree of antioxidant protection. Glutathione is non-enzymatic antioxidant which plays an important protective role against oxidative damages and lipid peroxidation. The aim of the present work is to determine the content of reduced and oxidized glutathione in sperm cells of infertile men. Semen samples from 20 fertile men (normozoospermics) and 72 infertile patients (12 oligozoospermics, 17 asthenozoospermics, 10 oligoasthenozoospermics and 33 leucocytospermic) were used. The total, oxidized (GSSG) and reduced (GSH) glutathione levels were measured spectrophotometrically. The levels of total glutathione were significantly lower in the spermatozoa of patients with oligozoo-, asthenozoo- and oligoasthenozoospermia than in the control. Infertile groups showed significantly decreased values of reduced glutathione in sperm cells vs. fertile men, indicating an alteration of oxidative status. The oxidized glutathione levels in sperm cells of infertile men did not differ from those of normozoospermic men with proven fertility. The GSH/GSSG ratio was significantly decreased in the oligo-, astheno- and oligoasthenozoospermic groups compared to the normozoospermic group. In patients with leucocytospermia the GSH/GSSG ratio was lower but these changes were not significant. In addition, glutathione peroxidase activity in sperm cells was decreased in patients with oligozoo-, astenozoo-, oligoastenozoospermia and with leucocytospermia. The most significant changes in glutathione peroxidase activity were observed in infertile men with leucocytospermia. Decreased GSH/GSSG ratio indicates a decline in redox-potential of the glutathione system in sperm cells of men with decreased fertilizing potential. Redistribution between oxidized and reduced forms of glutathione can be caused by depletion of intracellular stores of glutathione and intensification of lipid peroxidation processes. This leads to increased production of reactive oxygen species, further depletion of antioxidant pools and disturbances of structure and function of spermatozoa. Our results indicate that the evaluation of reduced glutathione level and GSH/GSSG ratio in sperm cells of infertile men can be helpful in fertility assessment.
The results of glutathione peroxidase and glutathione reductase activity in spermatozoa of patients with different forms pathospermia are presented in the paper. It was shown that glutathione peroxidase and glutathione reductase activity in sperm cells of patients is reduced in comparison with healthy men with preserved fertility. However, the most expressed changes in the activity of glutathione peroxidase and glutathione reductase are in spermatozoa of infertile men with associated forms patospermia and leucospermia. These changes indicate exhaustion of compensatory mechanisms of glutathione antioxidant system in the sperm cells of infertile men with pahospermia.
Na+,K+-ATPase plays an essential role in sperm motility, hyperactivation, chemotaxis, acrosome reaction etc. Na+,K+-ATPase is sensitive to ROS insult. Apart from production of highly reactive molecules, H2O2 can exert a number of direct effects on cells, their metabolism and enzymes. In the present study, exposure to exogenous H2O2 was used to characterize the effects of H2O2 on Na+,K+-ATPase activity in spermatozoa of infertile men with different forms of pathospermia. It was shown that Na+,K+-ATPase activities in spermatozoa of infertile men with different forms of pathospermia were inhibited by exposure to H2O2 (50−500 μM). H2O2, one of the most toxic oxygen species, has the ability to depress Na+,K+-ATPase activity in a dose-dependent manner. Severe inhibition of the hydrolytic activity was observed when higher H2O2 were used. The time course of incubation with 100 μM H2O2 showed a sharp decrease in the enzyme activity during the first 5 min of incubation for both normozoospermic and pathozoospermic men. The enzymatic activity of Na+,K+-ATPase in the sperm was completely destroyed at 20 min for asthenozoospermic men and 30 min for normozoospermic men. We show that an administation of H2O2 inhibited Na+,K+-ATPase activity in normozoospermic samples with IC50 of 106.6 ± 7.9 μM. IC50 for patients with asthenozoospermia was two times less than for healthy men with preserved fertility. For other studied groups, the differences in IC50 were not significant. These observations suggest that Na+,K+-ATPase in pathozoospermic samples is more vulnerable to H2O2-induced damage than in normozoospermic men. The Hill coefficient was significantly increased only for patients with asthenozoospermia, indicating increased positively cooperative binding. The decreases in Na+,K+-ATPase hydrolase activity in H2O2-treated sperm cells in men with normozoospermia were largely attenuated by exogenous GSH at 5 mM. This suggests that GSH partially protects the Na+,K+-ATPase from inhibition under experimental oxidative stress. However, treatment of oligo-, astheno- and oligoasthenozoospermic samples with 100 μM H2O2 and 5 mM GSH did not result in protection of Na+,K+-ATPase against induced oxidation, suggesting that the impaired Na+,K+-ATPase in pathozoospermic samples appears to be an irreversible event. In contrast, presence of GSH only after H2O2 treatment does not reverse Na+,K+-ATPase inhibition. This study has provided a deeper insight into the role Na+,K+-ATPase plays in sperm cells,it also could offer clues to the clinical application of antioxidant therapy in male infertility therapy.
Objective. To determine the role of oxidative stress and inflammation in the pathogenesis of subfertility/infertility and formation of autoimmunity in patients with cryptorchidism and varicocele. Material and metods. Blood levels of MDA and IL-6 were measured in 48 boys with cryptorchidism and 20 healthy subjects. The spermal parameters (motility, morphology), blood levels of MDA and IL-6 were measured in 22 men with varicocele and 21 healthy subjects. The statistical processing was performed with using noparametrical methods and standart computer programs (Statistica Version 6, StatSoft, Inc.; SPSS Statistics 17.0, IBM). Results. We showed that the level of МDA was significantly higher in blood of the cryptorchidism group compared with the control group (p=0.003). The blood serum concentration of IL-6 in the group with bilateral cryptorchidism as compared to the group with unilateral cryptorchidism was higher (p=0.001). We revealed that the levels of MDA, IL-6 and seminal parameters (low motility, sperm abnormalities) was higher in patients with varicocele compared to the control group (p<0.05; p=0.011). In our opinion, MDA is the most reliable and decisive biochemical marker displaying oxidative damage in undescended testes and varicocele, and may be triggered by an autoimmune response. Conclusions. The level of МDA is higher in blood of groups with bilateral and unilateral cryptorchidism, as well as in blood and seminal plasma of patients with varicocele. The higher level of MDA correlates with low motility and higher level of sperm abnormalities in patients with varicocele. The tendency of increased IL-6 level in blood of groups with bilateral and unilateral cryptorchidism, also in blood and seminal plasma of patients with varicocele is a ponderable factor of oxidative stress and a trigger of automunity.
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