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Analyse du statut spermatique, érectile et hormonal chez des patients hémodialysés

Erectile, seminal and hormonal profiles in haemodialysed patients

Basic and Clinical Andrology volume 21, pages 186–191 (2011)Cite this article

Résumé

But

Le but de notre travail était d’établir le profil hormonal, érectile et spermatique chez les patients hémodialysés et de rechercher l’impact des perturbations hormonales sur la fonction érectile (FE) et les paramètres spermatiques.

Patients et méthodes

Nous avons réalisé une étude transversale chez 30 sujets hémodialysés chez qui un spermogramme a été réalisé parallèlement à un bilan hormonal qui incluait le dosage sérique de FSH (follicle-stimulating hormone) et la testostérone totale. La FE a été évaluée par l’étude de l’indice international de la FE dans sa version française (IIEF-5). Le dosage des hormones sexuelles a été fait par la technique radio-immunologique, et la pratique du spermogramme a été faite selon les recommandations de l’OMS.

Résultats

Deux patients seulement avaient un spermogramme et un bilan hormonal normaux, l’IIEF était normal chez un seul patient.

Les patients azoospermiques (16 %) présentaient un eugonadisme hypergonadotrophique. Quarante pour cent des patients avaient une hypospermie. Un tiers des patients présentait une oligozoospermie sévère associée à un taux élevé de FSH dans 77 % des cas.

La mobilité et la morphologie spermatique étaient altérées dans respectivement 96 et 50 % des cas. Le bilan hormonal montrait une élévation de la FSH (> 8,5 mUI/ml) chez 40 % des patients, et la testostéronémie était diminuée (< 3,2 ng/ml) chez 25 % des patients. Deux patients présentaient un hypogonadisme franc (testostérone < 2 ng /ml).

Discussion

Le volume de sperme était diminué de façon significative chez les patients de plus de 30 ans. La FE était perturbée dans 73 % des cas avec un IIEF moyen de 15 (IIEF normal > 20). Plusieurs auteurs ont mis en évidence une corrélation entre le dysfonctionnement gonadique et les taux élevés de gonadotrophines chez l’homme présentant une insuffisance rénale chronique, avec ou sans atrophie testiculaire. Dans notre série, la testostéronémie était normale chez nos patients malgré l’absence de prise d’androgène. Les séances d’hémodialyses permettent-elles de préserver la fonction endocrine des testicules ?

Conclusion

Les patients au stade d’hémodialyse chronique d’une durée supérieure à un an présentaient un eugonadisme hypergonadotrophique ainsi qu’une insuffisance érectile. L’ancienneté de l’hémodialyse n’altère pas de manière significative les paramètres spermatiques ni la FE. Les patients d’un âge supérieur à 30 ans présentaient une diminution significative du volume spermatique qui pourrait être un marqueur déterminant de l’atteinte de la FE et de la fonction reproductive.

Abstract

Introduction

Our work was to establish the hormonal, semen and erectile profile among haemodialysed patients and to seek the impact of hormonal disturbances on erectile function and semen parameters.

Patients and methods

We conducted a cross-sectional study in haemodialysed patients in whom a semen, in parallel with hormonal analyses including FSH (follicle stimulating hormone) and testosterone. Erectile function was assessed by the study of the international index of erectile function in its French version (IIEF). Analyses of sex hormones were done by radio immunoassay and semen analyses according to WHO guidelines.

Results

Two patients had a semen analysis and a normal hormone balance; the IIEF was normal in a one patient. Azoospermic patients (16%) showed a hypergonadotrophic eugonadism. Forty percent of the patients had hypospermia without any correlation between hypospermia and hormonal values. One third of patients showed severe oligospermia associated with high levels of FSH in 77% of cases. Sperm motility and morphology were altered in 96% and 50% of the cases respectively. Hormonal analyses showed an elevated FSH (> 8.5 mUI/ml) in 40% of the cases and testosterone was decreased (< 3.2 ng/ml) in 25% of the cases.

Discussion

Semen volume was significantly decreased in patients over 30 years. Erectile function was disturbed in 73% of the patients with a mean IIEF score of 15. Several authors have shown a correlation between gonadal dysfunction and high levels of gonadotropins in men with chronic renal insufficiency, with or without testicular atrophy. In our series, testosterone was normal despite the absence of androgen. Are haemodialysis sessions effective in preserving the endocrine function?

Conclusion

Patients in chronic haemodialysis for a period exceeding one year had a hypergonadotrophic eugonadism and a severe erectile dysfunction. The state of the genital tract was relatively preserved. The duration of haemodialysis did not significantly affect sperm and erectile function. Patients older than 30 years showed a significant decrease in semen volume, which could be a marker to determine the impairment of erectile and reproductive functions.

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Authors and Affiliations

  1. Laboratoire de cytogénetique et biologie de la reproduction, hôpital universitaire F.-Hached, 4000, Sousse, Tunisie

    M. Ajina, W. Loussaief, N. Benjamaa & A. Saad

  2. Laboratoire de physiologies et des explorations fonctionnelles, 4000, Sousse, Tunisie

    M. Zaouali

  3. Unité de médecine de la reproduction, hôpital universitaire F.-Hached, 4000, Sousse, Tunisie

    S. Boughizane

  4. Service de néphrologie, hôpital universitaire F.-Bourguiba, 5000, Monastir, Tunisie

    A. Frih & M. El May

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Correspondence to M. Ajina.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ajina, M., Zaouali, M., Loussaief, W. et al. Analyse du statut spermatique, érectile et hormonal chez des patients hémodialysés. Basic Clin. Androl. 21, 186–191 (2011). https://doi.org/10.1007/s12610-011-0119-2

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Basic and Clinical Andrology

ISSN: 2051-4190