Panasovskyi M. Surgical treatment of acquired forms of obstructive azoospermia.

The thesis presents the substantiation of strategy of surgical treatment of male infertility acquired as a result of obstructive azoospermia by improvement of existing methods and development of new medical technologies applying the results of studying morphofunctional, hormonal and immunohistochemical changes in reproductive system. We obtained new and supplemented existing data on the pathogenesis of acquired obstructive azoospermia in men, based on an integrated analysis of correlations between the main biochemical parameters of seminal plasma, data on hormonal regulation of reproductive function and their comparison with clinical, hemorrhagic, morphofunctional, immunological and hemodynamic changes, which allowed to improve screening non-invasive diagnosis of acquired azoospermia and predict the effectiveness of surgical treatment. The study results showed that the morphological markers of the formation of irreversible pathological hypospermatogenesis in acquired obstructive azoospermia could be signs of polymorphic manifestations of inhibition of sperm maturation, tubular atrophy of the tubules and embryonic epithelium, desquamation, fibrosis and stromal hyalinosis with increased stromal-parenchymal index, increased expression of markers MMP-9 and TGF-β, the appearance of embryonic PLAP-positive cells. The research confirmed that long-term (more than 5 years) acquired obstructive azoospermia of infectious-inflammatory genesis caused the formation of autoimmune component of the disease with the appearance of antisperm antibodies in the blood, which is an unfavorable sign from the standpoint of restoring spermatogenesis after surgery and substantiates the preference of using puncture techniques in assisted reproductive technologies. We also proved that male infertility increased the possibility of developing anxiety-depressive and neurosis-like disorders, as well as disorders of interpersonal relations in the family, which has acute social significance and requires psychotherapeutic help. Additional diagnostic criteria for choosing surgical intervention on the basis of anamnestic, morphometric data and testicular blood circulation indicators were determined. The research established advantages of open biopsy over puncture in patients with obstructive azoospermia due to infectious and inflammatory diseases of the scrotum. Based on the obtained biopsy data of the testes and their appendages, we determined the advantages of epididymal sperm over testicular for their further usage in ICSI assisted reproductive technologies cycles. We substantiated the diagnostic-therapeutic algorithm of management of patients with acquired obstructive azoospermia, and proved its high efficiency for restoration of reproductive function of men.