Postępy Andrologii Online Advances in Andrology Online

Immunohistochemiczna lokalizacja interleukiny 6 (IL-6) w prostacie mężczyzn z łagodnym rozrostem gruczołu.
Lokalizacja sygnału w cytoplazmie komórek zrębu prostaty (brązowe zabarwienie).
Mikrofotografie autorstwa mgr mikrobiologii Weroniki Ratajczak, Zakład Histologii i Biologii Rozwoju, Pomorski Uniwersytet Medyczny w Szczecinie.
Immunohistochemical localization of interleukin 6 (IL-6) in prostate of man with benign prostatic hyperplasia.
Immunopositive signal in the cytoplasm of cells in prostate stroma (brown staining).
Micrographs by mgr of microbiology Weronika Ratajczak,
Department of Histology and Developmental Biology, Pomeranian Medical University in Szczecin

KOMITET REDAKCYJNY

Redaktor naczelny:
dr hab. n. med., prof. nadzw. PUM Małgorzata Piasecka, Szczecin
Zastępca redaktora naczelnego:
prof. dr hab. n. med. Jolanta Słowikowska-Hilczer, Łódź
Redaktor pomocniczy:
dr n. med. Kamil Gill, Szczecin
Sekretarz redakcji:
dr n. med. Agnieszka Kolasa-Wołosiuk, Szczecin
Skarbnik redakcji:
dr n. med. Renata Walczak-Jędrzejowska, Łódź

Sekretarz redakcji:
dr n. med. Agnieszka Kolasa-Wołosiuk, Szczecin
Skarbnik redakcji:
dr n. med. Renata Walczak-Jędrzejowska, Łódź

Członkowie komitetu redakcyjnego:
dr n. med. Szymon Bakalczuk, Lublin
dr n. med. Leszek Bergier, Kraków
prof. dr hab. n. biol. Barbara Bilińska, Kraków
prof. dr hab. n. med. Barbara Darewicz, Białystok
Prof., MD, PhD Aleksander Giwercman, Malmö, Sweden
PhD Yvonne Lundberg Giwercman, Malmö, Sweden
Prof., PhD (UPE/NMMU) and PhD (US) Gerhard Van der Horst, Republika Południowej
Afryki
(Bellville, Republic of South Africa)
prof. dr hab. n. med. Grzegorz Jakiel, Warszawa
prof. dr hab. n. med. Piotr Jędrzejczak, Poznań
dr hab. n. med., prof. UMK Roman Kotzbach, Bydgoszcz
prof. dr hab. n. med. Krzysztof Kula, Łódź
lek. med. Robert Kulik, Warszawa
prof. dr hab. n. med. Maria Laszczyńska, Szczecin
dr hab. n. med. Grzegorz Ludwikowski, Bydgoszcz
prof. dr hab. n. med. Marek Mędraś, Wrocław
MD, PhD, DMSc Ewa Rajpert-De Meyts, Kopenhaga, Dania (Copenhagen, Denmark)
dr n. med. Aleksandra Robacha, Łódź
dr n. med. Maria Szarras-Czapnik, Warszawa
Adres redakcji:
Katedra i Zakład Histologii i Biologii Rozwoju
Wydział Nauk o Zdrowiu
Pomorski Uniwersytet Medyczny w Szczecinie
71-210 Szczecin ul. Żołnierska 48
tel. 91 48 00 917, 91 48 00 908
e-mail: mpiasecka@ipartner.com.pl
Projekt grafi czny:
Agnieszka Hilczer
Waldemar Jachimczak
Małgorzata Piasecka
Jolanta Słowikowska-Hilczer
Korekta języka polskiego:
Wojciech Markowski
Korekta języka angielskiego:
Małgorzata Piasecka
Jolanta Słowikowska-Hilczer
Kamil Gill
Skład i łamanie:
Waldemar Jachimczak

O CZASOPIŚMIE / ABOUT THE JOURNAL

Wersja elektroniczna czasopisma jest wersją pierwotną. Informacje zawarte w czasopiśmie są udostępniane na zasadzie Open Access – dostęp do informacji naukowej jest bezpłatny i nieograniczony. Th e electronic version of the journal is a original version. Access to scientifi c information published in the journal is free and unlimited (Open Access).


Zaburzenia męskiego układu płciowego dotyczą osób w różnym wieku i w większości przypadków prowadzą do niepłodności, która nabrała już rangi choroby cywilizacyjnej. Najczęściej identyfi kowanymi nieprawidłowościami są hipogonadyzm, zaburzenia seksualne, wady rozwojowe narządów płciowych, nowotwory jąder i prostaty. Ze względu na specyfi czne i coraz bardziej zanieczyszczone środowisko antropogeniczne dotyczą one głównie społeczeństw rozwiniętych, w tym również Polski, i stanowią istotny oraz narastający problem medyczny, społeczny, demografi czny, a także zdrowia publicznego. Nauka, która zajmuje się fi zjologią i zaburzeniami męskiego układu płciowego w aspekcie nauk podstawowych i klinicznych, to andrologia. Ponieważ jest to młoda dziedzina nauki, jeszcze do niedawna niezadowalający stan wiedzy ograniczał możliwości diagnostyki oraz leczenia zaburzeń męskiego układu płciowego. Jednak w ostatnich latach obserwuje się niezwykle dynamiczny rozwój andrologii, szczególnie molekularnej, spowodowany wprowadzeniem nowych metod badawczych z zakresu biochemii, biologii i genetyki molekularnej. Andrologia staje się dziedziną interdyscyplinarną integrującą wiedzę z różnych dyscyplin medycznych i naukowych. Informacje związane z tymi zagadnieniami z trudem docierają do lekarzy i osób zainteresowanych w naszym kraju, ponieważ jest niewiele literatury w języku polskim, a wykłady wygłaszane podczas konferencji nie zawsze wyczerpująco wyjaśniają wątpliwości dotyczące m.in. postępowania diagnostycznego, terapeutycznego, rekomendacji czy też proponowanych algorytmów. Stąd też potrzeba stworzenia czasopisma prezentującego wiedzę andrologiczną lekarzom różnych specjalności, diagnostom laboratoryjnym i przedstawicielom nauk podstawowych. Czasopismo „Postępy Andrologii Online” powstało z inicjatywy Polskiego Towarzystwa Andrologicznego, które zainteresowane jest integracją środowiska osób zajmujących się różnymi aspektami męskiego układu płciowego, uzupełnieniem i poszerzeniem ich wiedzy, a także poprawą opieki zdrowotnej nad mężczyznami w naszym kraju. Celem czasopisma jest: 1) dostarczenie istotnych informacji na temat fi zjologii i patologii męskiego układu płciowego, 2) propagowanie praktycznej wiedzy andrologicznej kierowanej do szerokich kręgów odbiorców, 3) wymiana poglądów i opinii na temat zagadnień klinicznych oraz wyników badań doświadczalnych oraz 4) przekazywanie informacji dotyczących konferencji i kursów o tematyce andrologicznej. Proponowana tematyka czasopisma to: 1) andrologia kliniczna z uwzględnieniem etiopatogenezy, diagnostyki i leczenia m.in. zaburzeń rozwojowych, niepłodności i procesów starzenia mężczyzn, 2) nowatorskie metody diagnostyczne, 3) andrologia doświadczalna rozwijająca się w oparciu o nauki podstawowe oraz 4) inne interdyscyplinarne tematy związane z dziedziną andrologii. Czasopismo kierowane jest do lekarzy specjalności bezpośrednio lub pośrednio związanych z andrologią, m.in. urologów, endokrynologów, ginekologów, pediatrów, ale także do lekarzy rodzinnych spotykających się z coraz częstszym problemem niepłodności partnerskiej i problemami starzejących się mężczyzn. Ponadto naszą intencją jest zdobycie zainteresowania diagnostów laboratoryjnych odgrywających istotną rolę w prawidłowym postępowaniu terapeutycznym opartym na szerokim panelu testów i badań, których wdrożenie wciąż wymaga odpowiednich i wyczerpujących szkoleń z diagnostyki andrologicznej, w tym seminologicznej. Mamy nadzieję, że nasze czasopismo wzbudzi również zainteresowanie biologów zajmujących się czynnością męskiego układu płciowego w ramach nauk podstawowych, a także lekarzy weterynarii oraz innych osób, które znajdą informacje poszerzające ich wiedzę i kształtujące opinię z zakresu szeroko pojętych nauk andrologicznych. Zachęcamy Państwa do publikowania prac oryginalnych, kazuistycznych i krótkich komunikatów, jak również prac poglądowych, opracowanych w kondensacyjnej, dydaktycznej i przystępnej formie. W pracach tych autorzy powinni przedstawiać aktualny stan wiedzy światowej oraz swoje opinie. Chcemy, aby czasopismo spełniało rolę informatora i przewodnika w dziedzinie andrologii oraz stanowiło forum dyskusyjne. Ponadto, zapraszamy do publikowania artykułów będących tłumaczeniem publikacji ukazujących się w języku angielskim, które przedstawiają istotne postępy w andrologii. http://www.postepyandrologii.pl
Małgorzata Piasecka
redaktor naczelny
Jolanta Słowikowska -Hilczer
przewodnicząca
Polskiego Towarzystwa Andrologicznego


Disorders of the male reproductive system relate to people of diff erent ages and in most cases lead to infertility, which has already acquired a rank of a disease associated with the progress of civilization. Th e most frequently identifi ed irregularities are hypogonadism, sexual dysfunction, genital malformations, testicular or prostate cancer. Due to the specifi c and increasingly polluted anthropogenic environment they concern mainly developed societies, including Poland, and are an important and growing medical, social, demographic and public health problem. A science that deals with the physiology and with disorders of the male reproductive system in terms of the basic and clinical science is andrology. As this is a young fi eld of science, until recently an unsatisfactory state of knowledge limited the possibilities of the diagnostics and treatment of the disorders of the male reproductive system. However, in recent years there has been a very dynamic development of andrology, especially in the molecular aspect, due to the introduction of new methods of research in the fi eld of biochemistry, biology and molecular genetics. Andrology is becoming an interdisciplinary fi eld which integrates knowledge from various medical and scientifi c disciplines. Information related to these issues reach doctors and interested people in our country with diffi culty, because there is few publications in Polish. Lectures given during conferences also do not always fully explain the doubts concerning diagnostic and therapeutic proceedings, recommendations or proposed algorithms. Hence, the need for a journal presenting the knowledge of andrology to the doctors of various specialties, laboratory diagnosticians and representatives of the basic science. Th e journal „Progress in Andrology Online” is an initiative of the Polish Society of Andrology, which is interested in the integration of people involved in diff erent aspects of the male reproductive system, supplement and broadening their knowledge, as well as the improvement of health care for men in our country. Th e aim of the journal is: 1) to provide relevant information about the physiology and pathology of the male reproductive system, 2) the promotion of practical andrological knowledge directed to broad audiences, 3) to exchange views and opinions on issues of clinical andexperimental results, and 4) to provide information on conferences and courses on the subject of andrology. Th e proposed themes of the journal are: 1) clinical andrology including etiopathogenesis, diagnostics and treatment of developmental disorders, infertility and men’s aging, 2) innovative diagnostic methods, 3) experimental andrology developing on the basis of the basic sciences and 4) other interdisciplinary topics related to the fi eld of andrology. Th e journal is directed to physicians with specialty directly or indirectly related to andrology, including urologists, endocrinologists, gynecologists, pediatricians, but also to family doctors facing the increasingly common problem of couple infertility and problems of aging men. Moreover, our intention is to get the interest of laboratory diagnosticians playing an important role in keeping the correct therapeutic proceedings, based on a broad panel of tests and studies. Th eir implementation still requires proper and comprehensive training in andrological diagnostics, including seminological one. We hope that our magazine will also raise the interest of biologists dealing with the functions of the male reproductive system in the framework of basic sciences, as well as veterinarians and others who will fi nd information expanding their knowledge and shaping opinion in the range of broad sciences of andrology. We encourage you to publish original papers, case reports and short announcements, as well as review papers, worked out in the concentrated, didactic and accessible form. In these articles authors should present the current state of the global knowledge as well as their own opinions. We want the journal to act as an informer and a guide in the fi eld of andrology and become a forum for discussion. In addition, we invite you to publish articles that are translations of publications appearing in the English language, which present signifi cant progress in andrology.

Małgorzata Piasecka
redaktor naczelny
Jolanta Słowikowska -Hilczer
przewodnicząca
Polskiego Towarzystwa Andrologicznego

SPIS TREŚCI CONTENTS Tom6 Volum in 6 Strony 1–71 Pages 1–71 Czerwiec 2019 June 2019

O czasopiśmie / About Journal 4
Konferencja Polskiego Towarzystwa Andrologicznego – 21. Dzień AndrologicznySymposium of scientific training of the Polish Society of Andrology – 21th Day of Andrology 6
G.R. Dohle (przewodniczący), S. Arver, C. Bettocchi, T.H. Jones, S. KlieschRekomendacje dotyczące postępowania w męskim hipogonadyzmie Guidelines On Male HypogonadismTłumaczenie i przygotowanie wersji polskiej Translation and elaboration of Polish version: Katarzyna Jankowska, Jolanta Słowikowska-Hilczer 7
A. Jungwirth (przewodniczący), T. Diemer, Z. Kopa, C. Krausz, S. Minhas, H. TournayeRekomendacje dotyczące postępowania w niepłodności męskiej Guidelines on male infertility Tłumaczenie i przygotowanie wersji polskiej Translation and elaboration of Polish version: Katarzyna Jankowska, Jolanta Słowikowska-Hilczer 21
Artykuły poglądowe / ReviewMarta SochajCzynniki ryzyka zaburzeń erekcji Risk factors for erectile dysfunction 40
Marta Olszewska, Maciej KurpiszTranslokacje chromosomowe wzajemne (TCW) w niepłodności męskiej Reciprocal chromosome translocations (RCTs) in male infertility 51
Instrukcje dla autorów / Instructions for authors 68

KONFERENCJA POLSKIEGO TOWARZYSTWA ANDROLOGICZNEGO – 21. DZIEŃ ANDROLOGICZNY

SYMPOSIUM OF SCIENTIFIC TRAINING OF THE POLISH SOCIETY OF ANDROLOGY – 21th DAY OF ANDROLOGY
Łódź , 2 5 –26 .10 . 2019 ; www. pta2019.pl
Szanowni Państwo
Mam zaszczyt i przyjemność zaprosić na Konferencję Polskiego Towarzystwa Andrologicznego – 21. Dzień Andrologiczny, która odbędzie się w dniach 25–26 paź-dziernika 2019 r. w Łodzi.Konferencja będzie kolejną okazją do spotkania i wysłuchania polskich i zagranicznych ekspertów w zakresie andrologii, ale także urologii, endokrynologii, medycyny rozrodu, diagnostyki laboratoryjnej i biologii rozrodu, co pozwoli na poszerzenie wiedzy i ułatwi zdo-bycie umiejętności koniecznych w diagnostyce i leczeniu chorych z problemami męskiego układu płciowego. Myśl przewodnia konferencji koncentruje się wokół zdrowia i płodności mężczyzn, dlatego poruszane będą zagad-nienia z zakresu etiopatogenezy, diagnostyki i leczenia zaburzeń w tym zakresie. Zapraszamy do udziału nie tylko członków Polskiego Towarzystwa Andrologicznego, ale również wszystkich zainteresowanych andrologią kliniczną i doświadczalną. Intencją organizatorów jest wymiana doświadczeń i zaini-cjowanie współpracy w środowisku interdyscyplinarnym. Mamy nadzieję, że konferencja stworzy Państwu moż-liwości płynące ze współpracy lekarzy klinicystów, dia-gnostów i badaczy reprezentujących nauki podstawowe. Bogaty program naukowo-szkoleniowy przyczynił się do sukcesu poprzednich Dni Andrologicznych, których coroczna organizacja stała się już tradycją. Mamy nadzieję, że tak będzie i tym razem w Łodzi.

Prof. Jolanta Słowikowska-Hilczer
Przewodnicząca Polskiego Towarzystwa Andrologicznego

Dear Sir or Madam,
We are honoured and pleased to invite you to the Conference of Polish Andrology Society – 21th Day of Andrology, which will be held on October 25–26, 2019 in Łódź.The conference will be another opportunity to meet and listen to Polish and foreign experts in the field of andrology, but also to urology, endocrinology, reproduc-tive medicine, laboratory diagnostics and reproductive biology, which will allow to broaden knowledge and facili-tate acquiring skills necessary for diagnosis and treat-ment of patients with problems of the male system sexual intercourse. The main idea of the conference is focused on the health and fertility of men, therefore the issues related to etiopathogenesis, diagnosis and treatment of disorders in this area will be discussed.We invite to participate not only members of the Polish Andrology Society, but also everyone interested in clinical and experimental andrology. The intention of the organizers is to exchange experiences and ini-tiate cooperation in an interdisciplinary environment. We hope that the conference will create opportunities for you to cooperate with clinicians, diagnosticians and researchers representing basic science. The rich scientific and training program contributed to the success of the previous Days of Andrology, whose annual organization has already become a tradition. We hope that this will be the case in Łódź this time.

Prof. Jolanta Słowikowska-Hilczer
President of Polish Society of Andrology

REKOMENDACJE DOTYCZĄCE POSTĘPOWANIA W MĘSKIM HIPOGONADYZMIE

Przedstawiamy najnowsze rekomendacje Europejskiego Towarzystwa Urologicznego (EAU, ang. European Association of Urology) z 2018 r. dotyczące postępowania diagnostycznego i terapeutycznego w hipogonadyzmie i niepłodności u mężczyzn.Rekomendacje EAU z 2018 r. oparto na nowych, istotnych dowodach naukowych. Przeprowadzono obszerne wyszukiwanie piśmiennictwa, które obejmo-wało wszystkie dostępne wytyczne dotyczące męskiego hipogonadyzmu i niepłodności. Poszukiwania ograni-czały się do badań reprezentujących wysoki poziom dowodów naukowych, tj. systematycznych przeglą-dów z metaanalizą, randomizowanych badań kon-trolowanych i prospektywnych nierandomizowanych badań porównawczych, opublikowanych w języku angielskim

REKOMENDACJE DOTYCZĄCE POSTĘPOWANIA W MĘSKIM HIPOGONADYZMIEGUIDELINES ON MALE HYPOGONADISM

G.R. Dohle (przewodniczący), S. Arver, C. Bettocchi, T.H. Jones, S. KlieschTłumaczenie i przygotowanie wersji polskiej / Translation and elaboration of Polish version:Katarzyna Jankowska1, Jolanta Słowikowska-Hilczer
Otrzymano/received: 21.05.2019 r. Zaakceptowano/accepted: 5.07.2019 r
5.07.2019 r.DOI: 10.26404/PAO_2353-8791.2019.
Skróty / Abbreviations
BMI – indeks masy ciała (ang. body mass index); DA X1 – region krytyczny genu DSS-AHC1 chromosomie X/gen receptora kodowanego w specyficznym regionie chromosomu X, kórego duplikacja prowadzi do odwórcenia płci męskiej w żeńską, należący do podrodziny 0 receptorów jądrowych, grupy B1 (ang. dosage-sensitive sex reversal-adrenal hypoplasia congenita critical region on the X chromosome/nuclear receptor subfamily 0, group b, member 1 gene); EAU – Europejskiego Towarzystwa Urologicznego (ang. European Association of Urology); GnRH – gonadoliberyna (ang. gonadotropin-releasing hormone); HIV – ludzki wirus niedoboru odporności (ang. human immunodeficiency virus); LH – hormon luteinizujący (ang. luteinizing hormone); NYHA IV – IV stopień skali oceny niewydolności krążenia wg Nowojorskiego Towarzystwa Kardiologicznego (ang. Class IV of New York Heart Association functional classification system); PDE5 – fosfodiesteraza typy 5 (ang. phospho-diesterase type 5); PSA – antygen swoisty dla prostaty (ang. prostate specific antigen); SHBH – globulina wiążąca hormony płciowe (ang. sex hormone binding globulin)

Tabela 1. Przyczyny hipogonadyzmu pierwotnego

Piśmiennictwo cz_1

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REKOMENDACJE DOTYCZĄCE POSTĘPOWANIA W NIEPŁODNOŚCI MĘSKIEJ GUIDELINES ON MALE INFERTILITY

A. Jungwirth (przewodniczący), T. Diemer, Z. Kopa, C. Krausz, S. Minhas, H. TournayeTłumaczenie i przygotowanie wersji polskiej / Translation and elaboration of Polish version:Katarzyna Jankowska1, Jolanta Słowikowska-Hilczer2
Klinika Endokrynologii Centrum Medyczne Kształcenia Podyplomowego w Warszawie; 2 Zakład Endokrynologii Płodności, Katedra Andrologii i Endokrynologii Płodności, Uniwersytet Medyczny w Łodzi
Autor do korespondecji/corresponding author: Jolanta Słowikowska-Hilczer, Zakład Endokrynologii Płodności, Katedra Andrologii i Endokrynologii Płodności, Uniwersytet Medyczny w Łodzi, ul. Pomorska 251, 92-213 Łódź, tel.: 42 201 41 42, jolanta.slowikowska-hilczer@umed.lodz.pl
Otrzymano/received: 21.05.2019 r. Zaakceptowano/accepted: 5.06.2019 r.
DOI: 10.26404/PAO_2353-8791.2019.02



Skróty / Abbreviations

AZF – czynnik ulegający delecji w azoospermii (ang. azoospermic factor); CBAVD –wrodzony obustronny brak nasieniowodów (ang. conge-nital bilateral absence of the vas deferens); CFTR – gen kodujący regulator przewodnictwa przezbłonowego w mukowiscydozie(zwłóknienie torbielowate) (ang. cystic fibrosis fibrosis transmembrane conductance regulator gene); CIS – rak in situ (ang. łac. carcinoma in situ); FSH – hormon folikulotropowy (ang. follicle-stimulating hormone); GCT – nowotwór jądra typu zarodkowego wywodzący się z komórek płciowych (ang.germ cell tumor); HBV – wirus zapalenia wątroby typu B (ang. hepatitis B virus); hCG – ludzka gonadotropina kosmówkowa (ang. human cho-rionic gonadotropin); HCV – wirus zapalenia wątroby typu C (ang. hepatitis C virus); HIV – ludzki wirus niedoboru odporności (ang. human immunodeficiency virus); hMG –ludzka gonadotropina menopauzalna (ang. human menopausal gonadotropin); ICSI –docytoplazmatyczna iniekcja plemnika (ang. intracytoplasmic sperm injection); IHH – idiopatyczny hipogonadyzm hipogonadotropowy (ang. idiopathic hypo-gonadotrophic hypogonadism) ; ITGCN – ang. wewnątrzkanalikowy nowotwór z komórek płciowych (ang. intratubular germ cell neoplasia in situ); LH –hormone luteinizujący (ang. luteinizing hormone); LOH – hipogonadyzm późny (ang. late onset hypogonadism); MAR – mieszana reakcja z przeciwciałami przeciwko globulinie (ang. mixed antiglobulin reaction); MESA – mikrochirurgiczna aspiracja plemników z najądrzy (ang. ang. microsurgical epididymal sperm aspiration);PESA – przezskórna aspiracja plemników z najądrzy (ang. percutaneous epididymal sperm aspiration); mTESE – mikrochirurgiczne pobranie plemników z jąder (ang. microsurgicaltesticular sperm extraction); NOA – azoospermia nieobturacyjna, niezwiązana z niedrożnością dróg wyprowadzających plemniki (ang. non obstructive azoospermia); OA – azoospermia obturacyjna (ang. obstructive azoospermia); PESA – przezskórna aspiracja plemników z najądrzy(ang. percutaneous epididymal sperm aspi-ration); RN – ruch niepostępowy plemników (ang. non progressive sperm motility); RP – ruch postępowy plemników (ang. progressive sperm motility); SSRI – selektywne inhibitory wychwytu zwrotnego serotoniny (ang. selective serotonin reuptake inhibitor);TESE – ekstrakcja plemników z jąder (ang. testicular sperm extraction);TGCT – guz z komórek płciowych (ang. testicular germ cell tumor);WHO – Światowa Organizacja Zdrowia (ang. World Health Organization)

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