Sperm Granuloma Research Articles

A Male Surgical Contraceptive Method Based on Recommendations and Techniques Used in Vasectomy

Background: Vasectomy is a well-established method of male sterilization, offering a reliable and permanent contraceptive solution. Despite its effectiveness, the procedure remains underutilized due to limited counseling and awareness among patients. Objective: The objective of this study was to evaluate the efficacy and safety of a standardized vasectomy technique based on the 2012 American Urological Association (AUA) guidelines and to identify factors influencing postoperative outcomes and patient satisfaction. Methods: This prospective cohort study was conducted at the Department of Zoology, Rawalpindi Women University, from January 2022 to December 2023. A total of 150 male patients aged 25 to 50 years seeking permanent contraception were enrolled. Preoperative evaluations included detailed medical history, physical examination, and baseline semen analysis. The vasectomy procedures involved isolation, division, and management of the vasal ends using techniques such as proximal fascial interposition and thermal luminal fulguration. Postoperative care included instructions on scrotal support, avoidance of strenuous activities, and use of alternative contraception until azoospermia was confirmed through post-vasectomy semen analysis (PVSA) conducted at three months post-procedure. Data were analyzed using SPSS version 25, with statistical significance set at p < 0.05. Results: The mean age of participants was 37.5 years (range: 25-50 years). The overall efficacy rate was 98.7%, with 140 participants (93.3%) achieving azoospermia and 8 participants (5.3%) having less than 100,000 non-motile sperm/mL at three months post-procedure. Complications included infection (1.3%), hematoma (2.0%), chronic pain (2.7%), and sperm granuloma (0.7%). The mean VAS scores for pain were 2.3 at one week, 1.1 at one month, and 0.5 at three months post-procedure. Patient satisfaction was high, with 95% of participants reporting satisfaction with the procedure. Conclusion: This study demonstrated that vasectomy, when performed using standardized techniques, is a highly effective and safe method of male sterilization with high patient satisfaction and low complication rates. Enhanced preoperative counseling and follow-up are essential to optimize outcomes and increase the utilization of vasectomy as a contraceptive method.

UNILATERAL SPERMATIC CYST AND GRANULOMA IN THE BOVINE EPIDIDYMIS

In the bull, efferent tubules have gray-green apparence and can be visually defferentiaed from the rest of the tissue in the epididymal. Often, some sperm are trapped and die, relieving mycolic acid to produce a granulomatous reaction. Spermiostasis and sperm accumulation a consequence of the distention of abnormal efferent or epididymal tubules, with secondary formation of sperm granulomas in the region of the epididymal head. This condition is common in male goats and perhaps in sheep, less common in bulls. This study aimed to describe the macroscopic, histopathological and ultrasound aspects of sperm cyst and granuloma in a Sindhi breeder in Belém, Pará.

Studies on Breeding Failures in Dogs: A Review

The domestic dog is a non-seasonal breeder. The female is monestrus and has a reproductive cycle that is marked by extended periods of proestrus and estrus. The estrous period is characterized by an estrogen peak that coincides with rising circulating progesterone concentration prior to ovulation. After estrus is diestrus and then anestrus, with the ovarian cycle regulated by the hypothalamic-pituitary-gonadal axis. In the male spermatogenesis is controlled by the hypothalamic-pituitary-gonadal axis with testosterone playing a vital role. The reproductive cycle of most wild canids is similar to that of domestic dogs. Diestrus is followed by an extended period of ovarian inactivity. The causes of breeding failure in dogs are numerous and require thorough investigations for accurate diagnosis. Breeding failures can be infectious or non-infectious. Among the infectious causes in the bitch, bacterial endometritis was found to be responsible for the majority of reported cases. Non-infectious causes include primary and secondary anoestrus, cystic conditions of the uterus, and degenerative diseases of the endometrium. In the male, the causes can also be infectious and non-infectious. Non-infectious causes like bilateral cryptorchidism and acquired anatomical abnormalities can also cause male infertility. Spermatocele or sperm granulomas, obstruction of the genital ducts or inguinal or scrotal hernia, and prostatitis lead to infertility. Infections can lead to orchitis/epididymitis, with alteration of the quality of the semen. Nutrition also has important implications for reproductive performance. Undernutrition can result in loss of body condition, delay the onset of puberty, and ultimately lead to infertility.

Silica nanoparticles induces sperm granuloma formation and blood-epididymal barrier disruption via the p38 MAPK pathway in mice

Previous researches have demonstrated that the silica nanoparticles (SiNPs), which are widely used in all aspects of life, are hazardous to the male reproductive system. However, the cellular and molecular mechanism underlying SiNPs toxicity to the epididymis remain unclear. In this present study, a total of 60 male mice were separated into 4 groups and then treated to SiNPs for 7 consecutive days at a dose of 0, 2.5, 10, and 20 mg/kg body weight. The results showed that SiNPs could alter the histological structure of epididymis and induce sperm granuloma formation, leading to decreased sperm quality and quantity. In addition, the ultrastructure and permeability of blood-epididymal barrier (BEB) were impaired after exposure to SiNPs, and a significant downregulation of integral membrane proteins at the BEB was detected. SiNPs were also found to raise the percentage of macrophages in the epithelium and interstitium of the epididymis, followed by increased expression of pro-inflammatory molecules including TNF α, IL-1β, and IL-6. Meanwhile, SiNPs induced oxidative stress in epididymis, as shown by the markedly elevated generation of reactive oxygen species (ROS) and malondialdehyde (MDA) and upregulated activity of superoxide dismutase (SOD). Further study showed that SiNPs activated the p38 MAPK signaling pathway, which accelerated clathrin-mediated endocytosis of integral membrane proteins and perturb vesicular trafficking. Taken together, exposure to SiNPs could induce sperm granuloma formation and impair the integrity of BEB in mice through activating the p38 MAPK pathway.

Epididymitis in mice experimentally infected with Trypanosoma equiperdum: a histopathological and immunohistochemical study

Trypanosoma equiperdum is a causative agent of dourine in equids and is transmitted from stallions to mares by coitus. Dourine-affected stallions develop orchitis and epididymitis, and these lesions are considered to be responsible for the sexual transmission of T.equiperdum during coitus. However, the parasitic site of trypanosomes in the reproductive organs and the mechanisms underlying transmission have not yet been elucidated histopathologically. We examined the reproductive organs of male mice infected with T.equiperdum histopathologically and identified severe epididymitis with sperm granulomas. Many trypanosomes were detected in the epididymal interstitium and a few were seen within tubular lumen. Interstitial inflammatory cells mainly consisted of Iba1-, iNOS- and CD204-positive cells with a few CD3-, FOXP3- or PAX5-positive cells. There was diffuse immunolabelling of tumour necrosis factor-α (TNF-α) within these inflammatory foci. While caspase-3-positive epithelial cells in the epididymis were not observed in control mice, they were detected multifocally in infected mice and were frequently associated with loss of immunolabelling of zonula occludens-1 (ZO-1), a major protein that forms tight junctions between epididymal epithelial cells. Anti-laminin immunofluorescence revealed an indistinct basement membrane of the epididymal duct. These results suggest that trypanosomes in the epididymal interstitium induce the infiltration of TNF-α-secreting macrophages. Secreted TNF-α may impair the tight junctions of the epididymal duct by inducing apoptosis and downregulating ZO-1 expression.

Effects of Deslorelin on Testosterone Secretion and Testicular Volume in Male Rhesus Macaques (Macaca mulatta).

Sterility in male NHP has long been achieved through surgical castration or vasectomy. However, these techniques are irreversible, require a surgical procedure, and have potential consequences such as sperm granulomas and long recovery time. Deslorelin is a gonadotropin-releasing hormone agonist that temporarily and reversibly suppresses sex hormone secretion. Our goal in this study was to investigate the effects of deslorelin on testosterone secretion and testicular volume in male rhesus macaques (Macaca mulatta). Male macaques (n = 4) each received two, 4.7-mg deslorelin implants subcutaneously in the interscapular region. Serum testosterone and testicular volume were then monitored at specific time points until 10 mo after treatment. Testosterone suppression was defined as testosterone levels lower than 0.6 ng/mL for a sustained period of at least 30 d. After implantation, mean testicular volume was significantly reduced by day 121. Testosterone suppression was observed in all subjects. However, the time from implantation to testosterone suppression and duration of suppression varied. Two macaques were hormonally suppressed by day 26 after implantation and remained suppressed for at least 6 mo. The other 2 macaques were hormonally suppressed by 2 mo after implantation; of these two, one remained suppressed for 70 days while the other was suppressed for at least 245 days. We conclude that deslorelin can safely suppress testosterone secretion in male rhesus macaques, but individual variation in onset and duration of action should be considered when establishing reimplantation time points and potential return to reproductive activity.

Epididymal epithelial degeneration and lipid metabolism impairment account for male infertility in occludin knockout mice.

Occludin (OCLN) is a tight junction protein and Ocln deletion mutation causes male infertility in mice. However, the role of OCLN in male reproductive system remains unknown. In this study, we used an interdisciplinary approach to elucidate the underlying mechanism of male infertility in related to OCLN function, including Ocln knockout mice as well as a combined omics analysis and immunofluorescent labelling. Our results showed that the epididymis of Ocln-null mice displayed a phenomenon resembling epididymal sperm granuloma, which occurred especially in the junctional region between caput and corpus epididymidis. Sperm motility and fertilisation capacity were also impaired in these Ocln-null mice, accompanied by enlarged tubules in the proximal regions and degeneration in the distal regions of epididymis. Cellular localization analysis showed that OCLN immunofluorescence was enriched only in the apical junction of epithelial principal cells in the proximal regions of epididymis. Integrative omics analysis revealed the downregulation of gene clusters enriched in acid secretion and fatty acid metabolism in the Ocln-null epididymis, especially the enzymes related to the unsaturated arachidonic acid pathway. The number of proton-pump V-ATPase-expression clear cells, a key player of luminal acidification in the epididymis, declined drastically from prepubertal age before sperm arrival but not in the early postnatal age. This was accompanied by programmed cell death of clear cells and increased pH in the epididymal fluid of OCLN-deficient mice. The lipidomics results showed significantly increased levels of specific DAGs conjugated to unsaturated fatty acids in the Ocln-mutant. Immunofluorescent labelling showed that the arachidonic acid converting enzyme PTGDS and phospholipase PLA2g12a were prominently altered in the principal cells and luminal contents of the Ocln-mutant epididymis. Whereas the carboxylate ester lipase CES1, originally enriched in the WT basal cells, was found upregulated in the Ocln-mutant principal cells. Overall, this study demonstrates that OCLN is essential for maintaining caput-to-corpus epithelial integrity, survival of acid-secreting clear cells, and unsaturated fatty acid catabolism in the mouse epididymis, thereby ensuring sperm maturation and male fertility.

Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal.

The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post‐VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.

ETIOLOGICAL AND PATHOLOGICAL STUDY OF EPIDEDE/lY'I‘IS IN GOATS IN BAGHDAD CITY

Testes from 700 male goats aged l - 3 years , slaughtered at Baghdad abatteir, were examined during 6 months period. Histological and bacteriological examinations were done when gross lesions were observed. The results revealed that epidedimytis was observed in 21 (3%) of the examined animals ; 16 (2.3%) cases were unilaterally affected and S (0.7%) cases were bilaterally affected.&#x0D; Bacteriological isolations from infected organs included :&#x0D; Corynebacterium ovis (6 isolates) and Actinomyces pyogenes (3 isolates) both constituted the majonty of isolates ; as well as E. coli (4 iso-lates), and Pseudomonas aeruginosa , Staphylococcus epidermidis, Cory. bovis., Staph. aureus, Cory , ulcerams &amp;. Yersinia pseuclotuberculosis ( 2 isolates of each ) and Campylobacter fetus (1 isolate).&#x0D; Histopathological examination showed 6 pathological patterns of epididmytis including acute epididymitis (14.2% of infected cases ) , subacute nomsuppurative epididymilis (9.5% od cases ) , chronic suppurative epididymitisd (28.5% of cases ), chronic non—suppurative epididymitis (19% of cases) and spermatic granuloma (14.2% of cases ).

Epididymal Sperm Granuloma and Antisperm Antibodies in Donkeys

This study aimed to describe and compare semen parameters (pre-freeze and post-freezing) and antisperm antibodies (ASA) of donkeys with epididymal sperm granuloma and healthy controls. Feral donkeys (n = 10) castrated in a concurrent study were enrolled in the present experiment. Three donkeys had unilateral granulomas, two donkeys had bilateral granulomas, whereas the remaining five had grossly normal epididymides. The granulomas were either single or multiple, firm, well-circumscribed, tan to red, and 1–5 mm in size. Upon incision, abundant, thick, tan to white-yellow fluid was recovered. Histopathology revealed epithelioid macrophages, multinucleated giant cells, and abundant sperm cell fragments with mineralized cellular debris. Each epididymis was dissected, and semen harvested for cryopreservation. Semen was assessed for sperm motility parameters, plasma membrane integrity, and mitochondrial membrane potential. All donkeys had semen cryopreserved in a standard manner. In addition, post-thaw semen from all donkeys was assessed for ASA (IgG and IgA), acrosome integrity and morphology. Post-thaw, the progressive sperm motility and the percentage of sperm with an intact plasma membrane were reduced in donkeys with sperm granuloma (P = 0.04). There was no difference in total sperm motility, morphology, or damaged acrosome across groups (P > 0.05). Three donkeys with sperm granuloma (60%) displayed increased IgG and IgA ASA. In conclusion, sperm granulomas only marginally affected sperm quality and resulted in IgG ASA binding to sperm with damaged plasma membrane. It remains to be determined if sperm granuloma and ASA affect fertility in donkeys.

Duplicated vas deferens identified in post-mortem analysis

The identification of a duplicated Vas Deferens is significant during common operations such as vasectomies, groin explorations and hernioplasties. The reports are rare and incidental. Consequences of failure to identify this anomaly may yield effects such as sperm granulomas and vasovenous fistulas. We present the first publication of a duplicated vas from an Australian cadaveric dissection.

Review of Vasectomy Complications and Safety Concerns.

Vasectomy is a simple, safe, effective, and economical method used worldwide for long-term male contraception. As a surgical operation, it has short-term and long-term complications such as hematoma formation, infection, sterilization failure, sperm granulomas, short-term postoperative pain (nodal pain, scrotal pain, and ejaculation pain), and chronic pain syndrome. Whether it increases the risk of autoimmune disease, cardiovascular disease, testicular cancer, or prostate cancer is still controversial. Changes in plasma concentrations of luteinizing hormone, follicle-stimulating hormone, and testosterone after vasectomy have also been studied, as well as the relation between vasectomy and sexual function. Sperm quality decreases very slowly after vasectomy, and vasovasostomy and intracytoplasmic sperm injection could help a couple achieve a pregnancy if they change their minds at any point. We include a follow-up strategy and suggestions for follow-up care at the end of this review.

Modified Double-Layer Microsurgical Technique: Effective and Desirable Method for Vasectomy Reversal

Background: Family planning is one of the important needs of reproductive health care. For years, stable, reliable, reversible, accessible, and cost-effective methods have been desirable for this purpose. Vasectomy is often considered as the most common contraceptive method, due to the highly effective reversal success rate. Objectives: With the excellent patency and pregnancy rates, the microsurgical end-to-end vasovasostomy procedure has been recognized as a more common method for vasectomy reversal. Methods: Here we reviewed and analyzed the records of our experience of Modified Double-Layer microsurgical technique (MDLT) for the vasovasostomy procedure (n = 30) compared with the Three-Layer technique (TLT) (n = 24) during 3 years. The statistical analyses were carried out using SPSS (V. 15.0), and a value of P &lt; 0.05 was considered significant. Results: In this report, 54 participants underwent TLT-VV (group 1) and MDLT-VV (group 2). There was no significant difference in the causes of vasectomy reversal between the two groups (P value = 0.392). There was no significant difference between study groups in the fertility history (P value = 0.561), the presence of a sperm granuloma (P value = 0.21), underlying diseases (P value = 0.345) and demographic characteristics. We observed a 94% (51/54) patency rate and a 40.7% (22/54) pregnancy rate without any need for Assisted Reproductive technique (ART). Conclusions: The microscopic vasectomy reversal operation brings advantages to family planning and sexual health. High throughput return fertility, without any need for ART, places this technique in the first step of family planning. It seems Modified Double-Layer technique may be considered as the first step of microscopic vasovasostomy.

Initial clinical experience with simple orchiectomy procedures in the context of transition-related surgeries

Background: One of the more common procedures conducted through the transition-related surgeries (TRSs) program is simple orchiectomy. Due to the relative novelty of TRS in Canada, national perioperative guidelines for simple orchiectomy in the context of TRS are yet to be developed. Furthermore, there is a void in the literature describing the indications and outcomes of simple orchiectomy among transgender individuals.Aims: This study is the first descriptive case series in Canada highlighting our experience with simple orchiectomy in the context of TRS.Methods: This study retrospectively assessed data from electronic patient medical records of 16 patients who had simple orchiectomy procedures at Women’s College Hospital in Toronto, Canada from August 2018 to April 2019. Data were collected using a standardized data collection form which includes patient baseline demographic data, and objective and subjective clinical outcomes.Results: Mean age at surgery was 32.6 ± 10.4 years and mean time to surgery following the initial approval of referral was 9.9 ± 8.5 weeks. A majority of referrals (n = 13, 81.3%) were from urban areas with specialized TRS services. The average time on hormones was 3.1 ± 1.9 years. In terms of post-surgical complications at the 30-day day follow-up visit, there was a single post-operative sperm granuloma reported. There were no other complications identified post-surgery in our patient case series.Discussion: In Ontario, the growing recognition of the benefits of TRS has led to the development of a publicly funded pathway to TRS surgery. This study is the first assessment of simple orchiectomy performed for TRS in Canada, and it has shown that the procedure is safe and reproducible. Due to its benefits, coordinating safe and efficient access of care for this procedure should be an important action item for health systems. This study is limited by its low sample size.

Duplicated vas deferens as an incidental finding during indirect inguinal hernia repair: A case report and literature review.

Duplication of vas deferens is an anomaly that is generally encountered during inguinal hernia repair, orchiopexy, radical prostatectomy, varicocelectomy, and vasectomy. The estimated rate of this anomaly in the United States is 0.01%. This anomaly may predispose to iatrogenic vas deferens injury during inguinal hernia repair. Embryological point of view suggests that the duplication of the mesonephric duct system could result in duplicated vas deferens. Failure to recognize this anomaly may lead to injury, obstruction, or spermatic granuloma. Furthermore, it is important to identify duplicated vas deferens during vasectomy to avoid failure of the procedure. Identification of duplicated vas deferens is important during inguinal hernia surgery, vasectomy, and varicocelectomy. Herein, we report a case of duplicated vas deferens during open indirect inguinal hernia repair.

Surgical Experience of No-scalpel Vasectomy: An Underutilized Procedure

Introduction: No-Scalpel Vasectomy is a safe and effective technique of male fertility control. It is a minor procedure with minimal side effects and thus increases the patient acceptance, who have a vital role in decision making for family planning. Aims: to present our experience and results in patients undergoing no-scalpel vasectomy, their motivating factors, the failure rate of vasectomy, complications and its effect on sexual desire and performance. Material and Method : A total of 204 patients undergoing a no-scalpel vasectomy between march 2015 and august 2019 were included. Details about their motivational factors, socio-demographic profile were noted and post vasectomy complications were recorded and assesed. Results: No immediate or delayed complications of haematoma, wound infection, scrotal sinus, vasectomy failure, sperm granuloma and chronic scrotal pain was observed. Only one patient presented with pain and stitch granuloma which was excised later. None of our patients presented with any psychological and sexual problems in the follow-up. Conclusions: Men are often reluctant to consider vasectomy because of inaccurate information and myths. No-Scalpel Vasectomy is a safe procedure, but adequate motivation and education about the procedure is a must with follow up and sperm count at 3 months.

Historical control data for hematology parameters obtained from toxicity studies performed on different Wistar rat strains: Acceptable value ranges, definition of severity degrees, and vehicle effects

The physiological and health status of control animals may vary. Due to this variation, it is important to define acceptable ranges of control hematology parameters to gain a better understanding of adverse and non-adverse effects of test substances. After generating historical control data for two Wistar rat strains (RccHan™:WIST and Crl:WI(Han)) from different breeders, the data sets were statistically analyzed using Minitab®. After noticing that single outliers can affect the study control data set, the respective outliers were verified relative to the available histopathology findings, for example, inflammatory pulmonary lesions following vehicle aspiration or spontaneous sperm granuloma affecting the health status and hematology data of the respective animals. Such data points were excluded from the control data set. Comparing both data sets, it was obvious that different blood sampling and anesthesia methods as well as strain differences may result in slightly different values. After excluding the outliers, a data set from animals with presumably good health status was generated to define acceptable ranges and severity degrees. To evaluate effects, possibly influencing hematology parameters and defined acceptable ranges, selected vehicles and different study types were observed.

Motile cilia of the male reproductive system require miR-34/miR-449 for development and function to generate luminal turbulence

Cilia are cell-surface, microtubule-based organelles that project into extracellular space. Motile cilia are conserved throughout eukaryotes, and their beat induces the flow of fluid, relative to cell surfaces. In mammals, the coordinated beat of motile cilia provides highly specialized functions associated with the movement of luminal contents, as seen with metachronal waves transporting mucus in the respiratory tract. Motile cilia are also present in the male and female reproductive tracts. In the female, wave-like motions of oviductal cilia transport oocytes and embryos toward the uterus. A similar function has been assumed for motile cilia in efferent ductules of the male-i.e., to transport immotile sperm from rete testis into the epididymis. However, we report here that efferent ductal cilia in the male do not display a uniform wave-like beat to transport sperm solely in one direction, but rather exert a centripetal force on luminal fluids through whip-like beating with continual changes in direction, generating turbulence, which maintains immotile spermatozoa in suspension within the lumen. Genetic ablation of two miRNA clusters (miR-34b/c and -449a/b/c) led to failure in multiciliogenesis in murine efferent ductules due to dysregulation of numerous genes, and this mouse model allowed us to demonstrate that loss of efferent duct motile cilia causes sperm aggregation and agglutination, luminal obstruction, and sperm granulomas, which, in turn, induce back-pressure atrophy of the testis and ultimately male infertility.

Ethylene dimethane sulfonate (EDS) ablation of Leydig cells in adult rat depletes testosterone resulting in epididymal sperm granuloma: Testosterone replacement prevents granuloma formation

Sperm granuloma may develop in the epididymis following vasectomy or chemical insults. Inflammation due to sperm granuloma causes abdominal and scrotal pain. Prolonged and persistent inflammation in the epididymis due to sperm granuloma may lead to infertility. Extravasation of germ cells into the interstitium of epididymis following damage of the epididymal epithelium is one of the primary reasons for sperm granuloma-associated pathology. Since testosterone is vital for the maintenance of epididymal epithelium, we investigated the pathology of sperm granuloma and its relationship with testosterone. Adult rats were treated with a Leydig cell-specific toxicant ethylene dimethane sulfonate (EDS) to eliminate testosterone. At 7 days post-EDS, disrupted epididymal epithelium and sperm granuloma were observed in the caput epididymis. Sperm granuloma and caput were collagen-filled indicating fibrosis. Numerous round apoptotic cells were localized inside the caput lumen and dispersed through the sperm granuloma. Tnp1 (round spermatid marker) was significantly higher in the epididymis of the EDS-treated group compared to controls suggesting the apoptotic cells were round spermatids. Increases in CD68+ macrophages and T cells (CD4 and CD8) support an inflammatory immune infiltration in post-EDS epididymis. However, testosterone replacement following EDS prevented the sperm granuloma-associated pathology. We suggest that the immune response in the sperm granuloma may be due to the increased numbers of apoptotic round spermatids or other testicular tissue components that may be released, in addition to the regression of epididymal epithelium due to testosterone loss. Thus, testosterone replacement prevents EDS-induced sperm granuloma and ameliorates sperm granuloma-associated pathology.

Ultrasonic appearances of epididymal spermatic granuloma

Objective To explore the relationship between ultrasonic appearances of epididymal spermatic granuloma and its pathologic characteristics. Methods The sonographic features of 32 cases of epididymal spermatic granuloma confirmed by pathology were retrospectively analyzed. Results A total of 34 epididymal spermatic granuloma nodules in 32 cases included 4 located in caput epididymidis and 30 located in cauda epididymidis, and maximum diameter of nodules were about 0.5-2.3 cm. Sonographic and pathologic appearances of nodules were: ①mostly low echo type, 21 nodules mostly showed the obscure boundary and quite abundant blood flow signals, early granulomas formed with interstitial fibrosis inapparently under-microscope; ②inhomogeneous echo type, 12 nodules mostly showed the barely clear boundary and blood flow signals from small amount to abundant amount, granulomas of different maturites distributed dispersedly with interstitial fibrosis of varying degrees under-microscope or single giant lesions formed; ③mostly high echo type, 1 nodule showed the obscure boundary and inapparent blood flow signals, center of the nodules distributed by a large amount of dense fibrous tissue under-microscope. Anechoic ethmoid sinus seen in 29 nodules was section of dilated epididymal ductus. Dotted strong echoes seen in 6 nodules were calcification of sperms in dilated epididymal ductus and necrotic tissue. Conclusions Ultrasonic appearances of epididymal spermatic granuloma are closely related to its pathologic characteristics. To recognize both relations contributes to improve the diagnostic value of ultrasound. Key words: Ultrasonography; Spermatic Granuloma; Epididymis