mamakacTa meoradi uSvilobis ganviTarebis zogierTi Taviseburebani

s\s kanisa da ven-sneulebaTa s\k institutis andrologiuri ganyofilebis eqimi - g. galdava

ukanasknel wlebSi mamakacTa uSvilobis problemam samedicino-socialuri saxe miiRo. es dakavSirebulia mamakacTa sasqeso organoebis anTebiTi procesebis [6,7], ganviTarebis anomaliebis zrdiT, rac gamowveulia garemo pirobebis mavne faqtorebis zemoqmedebiT, mosaxleobis alergizaciiT, samkurnalwamlo saSualebebis farTod da ukontrolod miRebiT da sxva mravali faqtorebiT. fertilobis darRvevas mivyavarT uSvilo qorwinebebis zrdisaken, Sobadobis Semcirebisaken da demografiuli maCveneblebis gauaresebisaken. literaturuli monacemebiT [1,5] uSvilo qorwinebaTa ricxvma 10-15%-s miaRwia, romelTa Sorisac mamakacTa xvedriTi wili naxevarze mets Seadgens. Cveni qveynis monacemebis mixedviT [2] rogorc mamakacis, aseve qalis "braleuloba" uSvilo qorwinebaSi daaxloebiT Tanabaria da Seadgens 40-40%-s, xolo 20% SemTxvevaSi unayofo qorwinebis dros uSvilobis mizezad miiCneva orive erTad.

mamakacs meoradi uSviloba SeiZleba ganuviTardes organizmSi mimdinare mravali paTologiuri procesebis Sedegad, romlebic iwveven Teslgamtari sadinrebis distrofiul cvlilebebs, rasac SeiZleba paTospermiis ganviTareba mohyves.

infertiloba etiologiuri da paTogenezuri faqtorebis simravliT xasiaTdeba, romelTa Sorisac aRsaniSnavia sayofacxovrebo da garemo [4], endokrinuli da imunuri [3], genitaluri organoebis sxvadasxva anTebiTi procesebi [5,6,7] da sxva mravali faqtori.

kvlevis mizani iyo Segveswavla im mamakacebis eakulatis fertilobis darRvevis mizezebi, romlebsac qorwinebaSi hyavdaT erTi an meti Svili, magram Semdeg ramodenime wlis manZilze aRniSnavdnen uSvilobas. gamokvleuli pacientebis meuRleebi iyvnen praqtikulad janmrTelebi.

kvlevis masala da meTodebi – gamokvleulia 125 mamakaci, 25 –dan 37 wlamde, qorwinebaSi meoradi uSvilobiT. 101 (80,8%) imyofeboda pirvel qorwinebaSi, xolo 24 (19,2%) meoreSi. 88 (70,4%) hyavda 1 Svili, 32 (25,6%)-s ori, xolo 5 (4%)-s sami. yvela pacientis eakulati xasiaTdeboda sxvadasxva saxis darRvevebiT.

kliniko-laboratoruli gamokvlevebis dros, mamakacis organizmSi mimdinare paTologiuri procesebis gamosavlenad gamoyenebulia kvlevis baqteriologiuri, baqterioskopuli, bioqimiuri, imunofermentuli, imunofluorescentuli, imunologiuri, ultrabgeriTi meTodebi. eakulatis kvleva warmoebda jandacvis msoflio organizaciis mier mowodebuli rekomendaciebis gamoyenebiT. gansakuTrebul yuradRebas vuTmobdiT anamnezis srulyofilad Sekrebvas.

Sedegebis ganxilva – rogorc Cveni gamokvlevebiT irkveva mamakacTa meoradi uSvilobis ganviTarebaSi wamyvan faqtors warmoadgens SemTxveviTi sqesobrivi kontaqtebis Sedegad ganviTarebuli qronikulad mimdinare genitaluri organoebis infeqciur-anTebiTi procesi, romelic daudginda 57(45,6%) pacients. yvela SemTxveva garTulebuli iyo ureTro-prostatitiT an epididimitiT. maT Soris qlamidiuri infeqcia daudginda – 19-s, ureaplazmuri – 10-s, triqomonaduli – 17-s, xolo gonoreuli – 11 mamakacs.

genitaluri organoebis am paTologiuri procesebis dros viTardeba meoradi uSvilobis eqskretorul-toqsiuri da eqskretorul-obturaciuli formebi. uSvilobis eqskretorul-toqsiuri formis dros, eakulatis ganayofierebis unaris dakargva ganpirobebulia paTogenuri (qlamidiebi, triqomonadebi, ureaplazmebi) mikrobebis mier gamoyofili toqsikuri nivTierebebis zemoqmedebiT spermatogenul epiTelze.

meoradi uSvilobis paTogenezSi qronikuli prostatitis roli SeiZleba axsnili iyos anTebiTi procesis winamdebare jirkvalze gadasvliT. am dros ZiriTadad viTardeba uSvilobis eqskretorul-toqsiuri forma. gamokvlevebis dros sxvadasxva formisa da etiologiis qr. prostatiti daudginda - 65(52%) pacients, romelTagan - 57(87,7%) SemTxveva sqesobrivi gziT gadamdebi daavadebis Sedegad gamowveuli Tanmxvedri garTuleba iyo, danarCeni ki - abaqterialuri genezis.

anTebiTi procesis dros prostatis stromaSi acinusebisa da sadinrebis irgvliv aRiniSneba limfoiduri da plazmoiduri ujredebisagan warmoqmnili infiltratebi, viTardeba fibrioblasturi reaqcia da vaskuliti, epiTelis brtyelujredovani metaplazia. anTebiT-Cirqovani procesis dros mimdinareobs prostatikuli sadinrebis difuzuri infiltracia leikocituri ujredebiT, romlebic calkeul ubnebSi warmoqmnian sxvadasxva zomis Cirqovan kerebs. viTardeba Segubeba da jirkvlis stromis Canacvleba boWkovani, kolagenozuri, da sklerozuli qsoviliT. viTardeba winamdebare jirkvlis hipotrofia.

epididimitebis dros uSvilobis paTogenezSi viTardeba uSvilobis eqskretorul-obturaciuli forma. risi mizezic Teslsaval gzebSi warmoqmnili infiltraciuli procesebia, romelic mniSvnelovnad aferxebs eakulatis moZraobas. danamatis inficirebisa da anTebiTi procesis SemTxvevaSi, irRveva spermatogenezis procesi, radganac xdeba milakebis gadavseba spematozoidebiT da maTi daRupva.

genitaluri infeqciebis mier saTesle jirkvlis danamatis anTeba, gamokvlevebis dros daudginda 16(12,8%) pacients. rac infeqciis per continuitatem ukana ureTridan an limfohematogenuri gzebiT xdeba. amas xels uwyobs sqesobrivi agzneba, poluciebi, zogierTi ureTraluri manipulacia, fizikuri datvirTva, mwvave procesebis dros prostatis naadrevi masaJi, araswori mkurnaloba.

mamakacTa meoradi uSvilobis paTogenezSi didi mniSvneloba eniWeba saTesle jirkvlis venis varikozul gaganierebas. palpatoruli da ultrabgeriTi gamokvlevebiT davadgineT, rom 24(29,2%) fertilobadarRveul mamakacs saTesle jirkvlis venebis varikozuli gaganiereba (varikocele) hqonda, maT Soris: marjvenamxrivi mxolod 2(8,3%) SemTxveva dafiqsirda, xolo marcxenamxrivi 22(91,7%) pacients daudginda. yovelive es SeiZleba mxolod adamianis organizmis anatomiuri TaviseburebebiT aixsnas, romlis mixedviTac marjvena saTesle jirkvlis vena qvemo Rru venas erTvis ZiriTadad maxvili kuTxiT, iribad, maSin rodesac marcxena seTesle jirkvlis vena marcxena Tirkmlis venas uerTdeba perpendikularulad, rac marcxena Tirkmlis veniT, venuri sisxlis mdinarebis dabrkolebis pirobebSi retrograduli sisxlis dinebas iwvevs, e.i. yalibdeba varikocele.

varikoceleTi daavadebuli mamakacebis eakulatis fertiluri Tvisebebis gankargva gamowveulia Semdegi mizezebiT: 1) saTesle jirkvalSi sisxlis cirkulaciisa da kvebis darRveviT; 2) saTesle jirkvlebSi toqsiuri nivTierebebis dagrovebiT; 3) temperaturis momatebiT; 4) autoimunuri procesebis cvlilebebiT. spermogramis maCveneblebi icvleba daavadebis stadiisa da xangZlivobis Sesabamisad. varikoceles dros meoradi uSvilobis Camoyalibebisas wamyvani momentia sisxlis mimoqcevis SegubebiTi procesis ganviTareba venur sisxlZarRvebSi, romlis Semdeg iwyeba destruqciuli cvlilebebi herminatiul epiTelsa da spermatogenezis ujredebSi.

organizmSi mimdinare auto-imunuri procesebi did rols TamaSobs mamakacTa meoradi uSvilobis paTogenezSi. am procesebis ganviTareba ganpirobebulia genitaluri traqtis imunologiuri procesebis zogierTi TaviseburebebiT.

rogorc cnobilia spermatogenuri epiTeli, hematotestikuliaruli barieriT kargad aris daculi infeqciuri da toqsikuri zemoqmedebisagan. es barieri Zalian iSviaTad irRveva. misi dazianeba arsebiT rols TamaSobs UuSvilobis autoimunuri formis paTogenezSi.

swored autoimunuri procesebiT aris gamowveuli fertilobadarRveuli mamakacebis eakulatSi antispermuli antisxeulebis warmoqmna, romlebic iwveven spermatozoidebis aglutinacias, imobilizaciasa da spermatogenur qsovilSi destruqciul cvlilebebs.

gamokvlevebiT davadgineT, rom uSvilobis saerTo maCveneblebis fonze, organizmis auto-imunuri mdgomareobiT gamowveulma spermatozoidebis aglutinaciam Seadgina 12% (15 pacienti).

anamnezuri monacemebis safuZvelze irkveva, rom 4(3,2%) mamakaci meoradi uSvilobiT imyofeboda garemosa da samuSao mavne pirobebis zemoqmedebis qveS.

mniSvnelovan gavlenas eakulatis fertilobaze axdens alkoholisa da Tambaqos borotad (didi raodenobiT) gamoyeneba. Cvens mier gamokvleuli pacientebidan alkoholis didi raodenobiT momxmarebeli iyo 35(28%) mamakaci, xolo Tambaqosi - 68(54,4%).

meoradi uSviloba gamowveuli hormonaluri cvlilebebiT daudginda mxolod 2 pacients. am SemTxvevaSi viTardeba infertilobis sekretoruli forma.

rogorc irkveva, meoradi uSvilobis formireba mravali faqtoris zemoqmedebiTYSeiZleba ganviTardes, romlebzedac, mamakacis gamokvlevebis dros aucilebelia gamaxvildes praqtikosi eqimebis yuradReba.

daskvnebi:

1. mamakacTa meoradi uSvilobis paTogenezSi wamyvani roli eniWeba sqesobrivi gziT gadamdeb daavadebebs da maT mier gamowveul Sard-sasqeso sistemis sxvadasxva anTebiT procesebs, rac 45,6% davadgineT.

2. mamakacis organizmSi mimdinare auto-imunuri procesebi 12% SemTxvevaSi iwveven meoradi uSvilobis ganviTarebas.

3. meoradi infertilobis ganviTarebaSi arsebiT rols TamaSobs garemo, samuSao da sayofacxovrebo pirobebi.

literatura:

1. begiaSvili T, kapanaZe r. mamakacis spermis analizi uSvilo qorwinebis dros. meToduri rekomendacia. Tbilisi, 1978w.

2. kapanaZe r. andrologia. Tbilisi, 1993w.

3. Comhaire F.H., Mahmoud A.M., Depuydt C.E., Zalata A.A., Christophe AB. Department of Internal Medicine, University Hospital Ghent, Gent, Belgium. Mechanisms and effects of male genital tract infection on sperm quality and fertilizing potential: the andrologist's viewpoint. [Review] [79 refs] Human Reproduction Update. 5(5): 393-398, 1999 Sep-Oct.

4. Ludwig M., Dimitrakov J., Diemer T., Huwe P., Weidner W. Urologische Klinik, Justus-Liebig-Universitat Giessen. [Prostatitis syndrome. Changes in the ejaculate and effects on fertility]. [Review] [47 refs] [German]. Urologe - Ausgabe A. 40(1): 18-23, 2001 Jan.

Summary

From all the abovementioned we can conclude, that the development of secondary infertility in man is caused by variety of different factors. Research has revealed , that 45,6% of cased of secondary infertility are caused by sexually transmitted diseases and infectuas processes of urinaru and sexual organs; 12% of cases are caused by auto-immune processes that occur in organisms of man, and 3,2% of cases are triggered by unfriendly environment, and unsetisfactory working and living conditions. Timely identification of the above factors and adecuate treatment and preventive measures shall provide for substantial dicrease of overall rate of secondary infertility in man.

g. galdava

s/s kanisa da ven-sneulebaTa s/k instituti

tel. 899 507065, 961146

e-mail:ggaldava@hotmail.com