Fosfodiesteraz Tip-5 inhibitörlerinin semen parametrelerine etkisi

Bu derlemede, fosfodiesteraz inhibitörlerinin (PDEİ) semen parametreleri üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır. Literatürde, erektil disfonksiyon tedavisi için yaygın kullanılan PDEİ’nin semen parametreleri üzerinde de önemli etkileri olduğunu gösteren çok sayıda çalışma mevcuttur ve PDEİ bu etkilerini farklı yolaklar üzerinden göstermektedir. Deneysel çalışmalarda, genital sistemin birçok farklı organında PDE ekspresyonu gösterilmiştir. Bu ajanların uygulama dozu ve süresi de etkinlik için belirleyicidir. Örneğin, bir uzun etkili oral PDEİ olan tadalafilin terapötik dozda kullanımının semen parametrelerinde olumlu etkileri olduğu, ancak yüksek dozda uzun süre kullanımının olumsuz etkileri olduğu bildirilmiştir. PDEİ’ler, testiste, özellikle lamina propriada yol açtıkları histopatolojik değişikliklerle spermatogenez üzerinde etki gösterebilir. PDEİ’lerinin sperm motilitesi üzerinde de etkileri olabilir ve bu etkiler, pentoksifilin gibi non-spesifik PDEİ’ler ile de görülebilir; otokrin ve parakrin mekanizmalarla Leydig hücreleri üzerinden testosteron sentezi üzerinde de etki gösterebilir; androjen-bağlayıcı protein üzerinden Sertoli hücrelerine etki ederek sekretuar fonksiyonları arttırabilir. Semen hacmi, motil spermatozoa yüzdesi, sperm konsantrasyonu ve sperm morfolojisi, kronik PDEİ kullanımı ile birlikte artmaktadır. Sonuçta, oral PDEİ’lerin, uygun kullanıldığında, infertil erkeklerin semen parametrelerine olumlu etki yapmaları beklenmektedir

Effect of phosphodiesterase Type-5 inhibitors on semen parameters

In this review, it is aimed to evaluate the effects of phosphodiesterase inhibitors (PDEI) on semen parameters. There are numerous studies in the literature that show that PDEIs, which are widely-used for the treatment of erectile dysfunction, have also important effects on semen parameters and they exhibit these effects by different pathways. In experimental studies, PDE expressions have been demonstrated in various organs of the genital system. The dose and the duration of these agents also determines their effectiveness. For example, it has been reported that the use of a long-acting oral PDEI, tadalafil, has positive effects on semen parameters in a therapeutic dose, but has a negative impact on long-term use at high doses. PDEIs may have effects on spermatogenesis, caused by histopathological changes in the testes especially those in the lamina propria. PDEIs may also have effects on sperm motility, and these effects may also be seen with non-specific PDEIs such as pentoxifylline. They may also act on testosterone synthesis via Leydig cells with autocrine and paracrine mechanisms. They may increase secretory functions by acting on Sertoli cells through androgen-binding protein. Semen volume, motile spermatozoa percentage, sperm concentration, and sperm morphology increase with the use of chronic PDEI. In conclusion, the oral PDEIs, when used appropriately, are expected to make a positive impact on semen parameters of infertile men.

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