糖尿病对男性生育力的影响
Diabetes mellitus (DM) can affect male fertility potential in multiple ways. (1) Up to one-third of males with DM are found to have fertility issues. (2,3) Because of its widespread prevalence,it is important to screen at-risk males for DM in order to initiate an aggressive treatment regimen to prevent progression of sexual dysfunction and other medical problems.
糖尿病可以通过多种方式影响男性的生育力。(1)高达三分之一的糖尿病男性患者被发现有生育问题。(2,3)由于该病症在男性中普遍存在，对糖尿病高危群体的筛查变得尤为重要，以便开展积极的治疗方案，预防性功能障碍和其他医疗问题的发生。
The data regarding the effect of DM on spermatogenesis has been conflicting. Animal studies have suggested a decline in semen parameters with chronically uncontrolled or poorly 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 testosterone and increased sex hormone binding globulin levels. (2) DM can result in neurogenic and vasculogenic changes, resulting in sexual dysfunction.(4) Manifestations include erectile dysfunction and ejaculatory dysfunction (retrograde ejaculation, anorgasmia, etc. ) . Patients may also complain of decreased vibratory sensation to the penis, resulting in decreased arousal from physical stimulation. These disorders may prevent normal deposition of sperm within the female reproductive tract, resulting in infertility.
有关糖尿病对精子生成的影响的数据一直相互矛盾。针对动物的研究表明，血糖水平长期不受控制或控制不佳，会导致精液参数下降，尽管这一结果与在人体试验中的数据并不相符。(1,4) 由于睾酮水平低和性激素结合球蛋白水平升高，患有糖尿病的男性存在性腺机能减退的风险。(2)糖尿病可导致神经源性和血管源性改变，从而导致性功能障碍。(4)表现形式包括勃起功能障碍和射精功能障碍(逆行射精、性快感缺失等)。患者还可能抱怨阴茎的振动感降低，导致身体刺激引起的快感减少。 这些疾病可能会阻碍精子在女性生殖道内正常沉积，从而导致不育。
Treatment of males 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 bladder neck closure. If these are unsuccessful, urinary alkalinization with oral sodium bicarbonate can decrease the caustic effects of urine on sperm function and viability. The postejaculatory urine can be processed and the collected sperm used for insemination or IVF. Erectile dysfunction can be treated with various medications including phosphodiesterase inhibitors (i.e. sildenafil,vardenafil,tadalafil) ,prostaglandin El intraurethral suppository, or intracavernosal injection. Surgical therapy includes placement of a penile prosthesis. Unfortunately, decreased penile sensation and anorgasmia are untreatable, although surgical sperm retrieval can be performed in this setting for IVF.
男性糖尿病的治疗包括严格控制血糖以防止性功能持续下降。 逆行射精的具体治疗包括α-激动剂和三环类抗抑郁药以刺激膀胱颈闭合。 如果这些方法都无效， 用口服碳酸氢钠碱化尿液可以减少尿液对精子功能和活力的腐蚀性作用。 可对射精后所排的尿液进行处理，收集其中的精子用于授精或体外受精。勃起功能障碍可以用多种药物治疗，包括磷酸二酯酶抑制剂(即西地那非、伐地那非、他达拉非)、前列腺素 El 尿道内栓剂或海绵体内注射。手术治疗包括放置阴茎假体。不幸的是，尽管这种情况下可以取精为辅助生育治疗做准备，但阴茎感知力下降和性快感缺失是无法治疗的。
Reference 文献参考：
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