Diabetes mellitus (DM) can affect male ftility potential in multiple ways. (1) Up to one-third of ma with DM are found to have ftility issues. (2,3) Because of its widespread prevalence,it is important to screen at-risk ma for DM in ord to initiate an aggressive treatment regimen to prevent progression of sexual sfunction and oth medical problems.
糖尿病可以通過多種方式影響男性的生育力。(1)高達(dá)三分之一的糖尿病男性患者被發(fā)現(xiàn)有生育問題。(2,3)由于該病癥在男性中普遍存在，對(duì)糖尿病高危群體的篩查變得尤為重要，以便開展主動(dòng)
的治療方案，預(yù)防性功能障礙和其他醫(yī)療問題的發(fā)生。
The data regarding the effect of DM on spmatogenesis has been conflicting. Animal studies have suggested a decline in semen paramets with chronical uncontrolled or poor controlled blood glucose levels, although this has not been found to be consistent in human studies. (1,4) Men with DM are at risk for developing hypogonadism due to low testostone and increased sex hormone binding globulin levels. (2) DM can result in neurogenic and vasculogenic changes, resulting in sexual sfunction.(4) Manifestations include ectile sfunction and ejaculatory sfunction (retrograde ejaculation, anorgasmia, etc. ) . Patients may also complain of decreased vibratory sensation to the penis, resulting in decreased arousal from physical stimulation. These disords may prevent normal deposition of spm within the female reproductive tract, resulting in inftility.
有關(guān)糖尿病對(duì)精子生成的影響的數(shù)據(jù)一直相互矛盾。針對(duì)動(dòng)物的研究表明，血糖水平長(zhǎng)期不受控制或控制不佳，會(huì)導(dǎo)致精液參數(shù)下降，盡管這一結(jié)果與在人體試驗(yàn)中的數(shù)據(jù)并不相符。(1,4) 由于睪酮水平低和性激素結(jié)合球蛋白水平升高，患有糖尿病的男性存在性腺機(jī)能減退的危險(xiǎn)
。(2)糖尿病可導(dǎo)致神經(jīng)源性和血管源性改變，從而導(dǎo)致性功能障礙。(4)表現(xiàn)形式包括勃起功能障礙和射精功能障礙(逆行射精、性性?shī)^
缺失等)。患者還可能抱怨陰莖的振動(dòng)感降低，導(dǎo)致身體興奮引起的性?shī)^
減少。 這些疾病可能會(huì)阻礙精子在女性生殖道內(nèi)正常沉積，從而導(dǎo)致不育。
Treatment of ma with DM includes strict glucose control to prevent continuing decline in sexual function. Specific treatments for retrograde ejaculation include a-agonists and tricyclic antidepressants to stimulate bladd neck closure. If these are unsuccessful, urinary alkalinization with oral sodium bicarbonate can decrease the caustic effects of urine on spm function and viability. The postejaculatory urine can be processed and the collected spm used for insemination or IVF. Erectile sfunction can be treated with various medications including phosphodiestase inhibitors (i.e. sildenafil,vardenafil,tadalafil) ,prostaglandin El intraurethral suppository, or intracavnosal injection. Surgical thapy includes placement of a penile prosthesis. Unfortunate, decreased penile sensation and anorgasmia are untreatable, although surgical spm retrieval can be pformed in this setting for IVF.
男性糖尿病的治療包括嚴(yán)格控制血糖以防止性功能持續(xù)下降。 逆行射精的具體治療包括α-激動(dòng)劑和三環(huán)類抗抑郁藥以興奮膀胱頸閉合。 如果這些方法都無效， 用口服碳酸氫鈉堿化尿液可以減少尿液對(duì)精子功能和活力的腐蝕性作用。 可對(duì)射精后所排的尿液進(jìn)行處理，收集其中的精子用于授精或體外受精。勃起功能障礙可以用多種藥物治療，包括磷酸二酯酶控制劑(即西地那非、伐地那非、他達(dá)拉非)、前列腺素 El 尿道內(nèi)栓劑或海綿體內(nèi)注射。手術(shù)治療包括放置陰莖假體。不幸的是，盡管這種情況下可以取精為輔助生育治療做準(zhǔn)備，但陰莖感知力下降和性性?shī)^
缺失是無法治療的。
Refence 文獻(xiàn)參考：
1. Agbaje IM, Rogs DA, McVicar CM,et al. Insulin dependant diabetesmellitus:implications for male reproductive function. Hum Reprod.2007; 22: 1871-77
2. Kasturi SS, Tannir J, Brannigan RE. The metabolic syndrome and maleinftility. J Androl. 2008; 29: 251-9
3. Ben A, Al-Ansari AA, Zirie M, Al-Hamaq AO. Is male ftility associatedwith type 2 diabetes mellitus? Int Urol Nephrol.2009;41:777-84
4. Mulholland J, Mallidis C, Agbaje I,McClure N.Male diabetes mellitusnd assisted reproduction treatment outcome. Reprod BiomedOnline. 2011; 22: 215-9.
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