Варикоцелэктомия: критический анализ предикторов восстановления репродуктивной функции


DOI: https://dx.doi.org/10.18565/urology.2020.6.148-154

А.Б. Шомаруфов, В.А. Божедомов, Ш.И. Гиясов, Ш.А. Аббосов, А.А. Камалов

1) Кафедра урологии и андрологии факультета фундаментальной медицины и МНОЦ ГОУ ВПО МГУ им. М. В. Ломоносова, Москва, Россия; 2) кафедра урологии Ташкентской медицинской академии, Ташкент, Узбекистан
Варикоцеле является одной из самых частых корригируемых причин мужской субфертильности.
По результатам последних мета-анализов рандомизированных контролируемых исследований, варикоцелэктомия в целом приводит к достоверному улучшению качества эякулята и тем самым – к фертильности мужчины. Однако эффективность коррекции варикоцеле в среднем составляет 55–70%, т.е. 30–40% бесплодных мужчин варикоцелэктомия не помогает. Целью нашего обзора стали поиск и анализ данных литературы, касающихся клинико-анамнестических и лабораторно-инструментальных предикторов, положительно или отрицательно влияющих на эффективность коррекции варикоцеле. По результатам анализа мы систематизировали изученные предикторы по сумме баллов, которую определяли на основании количества и качества исследований, подтверждающих или отвергающих изучаемый предиктор как значимый по трем уровням достоверности: предикторы высокого, среднего и низкого уровней достоверности. К предикторам высокого уровня достоверности были отнесены исходные показатели спермограммы, уровень фрагментации ДНК сперматозоидов и УЗ-допплерографическая картина сосудов яичка. Исходный уровень фолликулостимулирующего гормона в крови и объем яичек были включены в группу предикторов среднего уровня достоверности. В то же время такие факторы, как возраст мужчины и его супруги, степень варикоцеле, а также длительность бесплодия, вошли в группу предикторов низкого уровня достоверности. Таким образом, нами проведена «градация» предикторов эффективности коррекции варикоцеле у субфертильных мужчин на основании анализа доказательной базы каждого предиктора.
Ключевые слова: варикоцеле, предиктор, субфертильность, варикоцелэктомия, спермограмма

Литература


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Об авторах / Для корреспонденции


А в т о р д л я с в я з и: А. Б. Шомаруфов – аспирант кафедры урологии и андрологии факультета фундаментальной медицины МГУ им. М. В. Ломоносова, Москва, Россия, e-mail: doctor.shomarufov@gmail.com


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