Sperm Granuloma Research Articles

Experimental epididymitis due to Chlamydia trachomatis in rats.

A new animal model of epididymitis due to Chlamydia trachomatis was developed. Adult male Wistar rats were inoculated in the vas deferens with C. trachomatis biovar mouse pneumonitis. After infection, C. trachomatis was recovered from the epididymides for up to 90 days. At day 30, organisms were also reisolated from the testes. Clinical findings included enlargement of infected epididymides and concurrent atrophy of the ipsilateral testes. Histological lesions in the epididymides consisted of pyogranulomatous inflammation, abscesses, and spermatic granulomas. Infection of the testis by C. trachomatis was associated with pyogranulomatous changes. In addition, testicular degeneration, characterized by moderate to severe loss of the germinal epithelium, was noted. Chlamydial antigen was detected within epithelial cells, intratubular macrophages, and macrophages in the stroma of the epididymis by immunoperoxidase staining. This rat model of chlamydial epididymitis appears to clinically and histopathologically mimic the human disease. This model offers the opportunity for further studies on the pathogenesis and sequelae of chlamydial epididymitis.

Vasectomy and spermatic granuloma in hamsters

Fifty-eight hamsters were bilaterally vasectomized either 1, 2, 3 or 6 months before experimentation. Fifty-five sham-vasectomized hamsters served as control. Cauda epididymal fluid was obtained by micropuncture. The effect of vasectomy on the incidence of spermatic granuloma was studied. The data were analyzed according to the presence or absence of granuloma after vasectomy and were compared with the data of their respective control. The incidence of granuloma increased with the duration of vasectomy and reached 92.8% at the end of 6 months after operation. Distension of the epididymis increased to a maximum at 1 month, but recovered to nearly normal irrespective of the existence of granuloma. The weight of the testis, spermatocrit and sperm density significantly decreased, and the percentage of abnormal sperm in the cauda and caput increased markedly in the absence of granuloma compared with their respective tract with granuloma or control. The testes in both the group with and without granuloma showed marked atrophy 6 months after vasectomy. The concentration of carnitine in the cauda epididymal plasma was significantly reduced from 2–6 months. The possible protective effect of a granuloma formation is discussed.

Autotransposition of vas in a 2-stage procedure. An experimental study in the rat.

The patency rate of vasovasostomy in autotransposed vas has been studied using a technique set up in a rat model. In a two-stage procedure, 1 cm of the vas deferens was transposed to the opposite side. The anastomoses were performed with a simplified microsurgical suturing technique. On final examination, 9 of 15 rats operated upon showed good sperm passage over the transposed vas segment. Sperm granulomas were recorded in four of fifteen cases. Sperm antibodies were demonstrated in eight of fifteen cases.

T and B Lymphocyte Subsets in Spermatic Granulomas in Five Rams

Epididymal spermatic granulomas from five adult (greater than 4 years old) rams from a commercial flock were evaluated by quantitative histologic methods. Sections were stained for isotype specific immunoglobulin (Ig)-containing cells or specific lymphocyte subsets, as indicated by plasma membrane staining with monoclonal antibodies (MoAb). For the purpose of analysis, individual spermatic granulomas were allocated to one of three groups (early, resolving, or intermediate) on the basis of histologic examination. Ig-containing cells were most prevalent in early spermatic granulomas, and IgG-containing cells predominated in all spermatic granulomas regardless of their presumed age. IgM immunoglobulin-containing cells were the next in prevalence, and IgA-containing cells were infrequent. Assessment of lymphocyte subsets confirmed that lymphocytes present were of both T- and B-cell lineage and were well represented in all spermatic granulomas. CD4+ (MHC Class II-restricted "helper") T-cells were more prevalent in early spermatic granulomas than in intermediate or resolving types, while CD8+ (MHC Class I-restricted, "cytotoxic/suppressor") T-cells were more prevalent in spermatic granulomas of the intermediate type. These results suggest that in addition to an essentially foreign body reaction to extravasated spermatozoa, both local production of antibody and accumulation of a variety of B- and T-lymphocytes are present in ovine spermatic granulomas.

Microsurgical Epididymovasostomy by Loop Intussusception

A new technique, epididymal loop intussusception into the vas deferens, is offered as an improved form compared with the side-to-end method. Loop intussusception has been experimentally studied bilaterally in 15 adult male rats. This report provides details of the technique. A 3-month anatomical and histological follow-up showed a 100% patency rate, no anastomotic stricture, and reabsorption of the blind intussuscepted loop in all but 3 cases. Macroscopic sperm granulomas were present in only 10% of the anastomoses examined. Advantages and disadvantages of microsurgical epididymovasostomy techniques are discussed.

Stented Laser-Welded Vasovasostomy in the Rat: Comparison of Nd:YAG and CO2Lasers

In 54 male Sprague-Dawley rats, 108 vasovasostomies were performed. Sutureless laser welding with the assistance of a removable stent was done using a CO2- and an Nd:YAG-laser system. Conventional two-layer microsurgical anastomoses served as controls. The Nd:YAG laser resulted in significantly lower patency rates, with a higher percentage of sperm granulomas; the CO2 laser produced results equivalent to conventional suturing. Sutureless laser welding utilizing a removable stent proved to be a time- and cost-saving procedure for vasovasostomies in the rat.

Fibrin Glue Vasal Anastomosis Compared To Conventional Sutured Vasovasostomy in the Rat

Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue (“Tisseel”, Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (<3mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy.The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.

Results of 1,469 Microsurgical Vasectomy Reversals by the Vasovasostomy Study Group

During a 9-year period 1,469 men who underwent microsurgical vasectomy reversal procedures were studied at 5 institutions. Of 1,247 men who had first-time procedures sperm were present in the semen in 865 of 1,012 men (86%) who had postoperative semen analyses, and pregnancy occurred in 421 of 810 couples (52%) for whom information regarding conception was available. Rates of patency (return of sperm to the semen) and pregnancy varied depending on the interval from the vasectomy until its reversal. If the interval had been less than 3 years patency was 97% and pregnancy 76%, 3 to 8 years 88% and 53%, 9 to 14 years 79% and 44% and 15 years or more 71% and 30%. The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures and they were statistically the same for all patients regardless of the surgeon. When sperm were absent from the intraoperative vas fluid bilaterally and the patient underwent bilateral vasovasostomy rather than vasoepididymostomy, patency occurred in 50 of 83 patients (60%) and pregnancy in 20 of 65 couples (31%). Neither presence nor absence of a sperm granuloma at the vasectomy site nor type of anesthesia affected results. Repeat microsurgical reversal procedures were less successful. A total of 222 repeat operations produced patency in 150 of 199 patients (75%) who had semen analyses and pregnancy was reported in 52 of 120 couples (43%).

Microsurgical epididymovasostomy by tubule intussusception: a new technique in rat model

This experimental study on 15 adult male rats with bilateral epididymovasostomies evaluates a new technique of tubule intussusception as an improved form of end-to-end anastomosis. This paper describes in detail the steps in this technique and offers physiological, anatomical, and histological follow-up after 3 months. With this technique there is a 97% patency rate and a 23.3% incidence of macroscopic spermatic granuloma. Complications are discussed in detail.

結節性精管炎

Two cases of vasitis nodosa are reported hereon. The two patients were 47 and 40 year old males with desire of refertility. They were performed vasectomy 23 and 10 years ago. They were subjected to vaso-vasostomy. During the operations, spindle shaped nodules were found in the vas deferens at the site of the previous vasectomy. Histologically, they showed focal proliferation of epithelial components forming glands, where a plentiful number of sperms were present, and this was also associated with proliferative change of smooth muscle bundles of vas deferens. Some foci of spermatic granulomas were also found. This condition was similar those of salpingitis isthmica nodosa in the fallopian tube. Vasitis nodosa should be differentiated from metastatic adenocarcinoma histologically. This condition may lead to re-canalization.

ビーグル犬にみられた精巣上体の精子肉芽腫

Pathological examination of a 9-month-old beagle dog revealed the epididymal spermatic granuloma. Grossly, a white nodule was observed in the cauda epididymis on the right side. Microscopically, there were numerous spermatozoa in the center of granuloma, surrounded by a wall of macrophages, fibroblasts, plasma cells, lymphocytes, neutrophils and giant cells. Furthermore, many macrophages containing IgG were observed in the center of granuloma.

Vasectomy and the human testis.

Just as concerns that vasectomy might predispose its acceptors to cardiovascular disease have been largely discounted, Cole et al. have obtained results suggesting that vasectomy accelerates the growth of testicular tumors. Out of a cohort of over 3000 vasectomized men in Scotland, 8 developed testicular cancer within 4 years of the procedure. The expected number of cases would be 1.9. Earlier, Thornhill et al reported 3 cases of a rare mixed seminoma and malignant teratoma 8 weeks after vasectomy. Numerous studies have found abnormalities in testicular biopsy specimens from vasectomized men. These changes include degeneration of seminiferous epithelium, loss of germ cells such as spermatids, dilatation of testicular tubules, thickening of tubular walls, and interstitial fibrosis. More research is needed on factors (i.e., a history of orchitis or family history of autoimmune disease) that may predispose men to different forms of testicular change as well as the association between the formation of sperm granulomas and testicular abnormalities. Most important, however, is further investigation of the proposed association of vasectomy and accelerated tumor growth.

Fluid movement in the lumen of the rat epididymis: effect of vasectomy and subsequent vasovasostomy.

Intraluminal fluid movement rate was measured in four regions of the rat epididymis. The fastest flow occurred in the proximal caput epididymis (18.5 +/- 3.7 mm/hour) and the slowest in the distal cauda (2.5 +/- 0.5 mm/hour). Vasectomy significantly reduced caput fluid flow rates unless a sperm granuloma was present at the vasectomy site. Thirty days after vasovasostomy, caput fluid movement remained reduced in animals unless a granuloma was present. Failures of this or other aspects of epididymal biology to return to normal after vasovasostomy could play a role in the frequent infertility which persists after the operation.

Multiple effects of ethane dimethanesulfonate on the epididymis of adult rats

Ethane dimethanesulfonate (EDS), a Leydig cell toxicant which results in transient infertility, was used in a 4 day postexposure experimetal protocol designed to identify any effects this compound might exert on the epididymis. The techniques of efferent duct ligation and testosterone (T) implantation were used to negate the role of testicular effects on the epididymal parameters. Numerous evaluations were performed including light and electron microscopy, computer assisted sperm motion analyses, and electrophoresis of sperm membrane proteins. EDS was shown to affect the epididymis in a dose-dependent fashion. The action of EDS on the epididymis is in part due to Leydig cell cytotoxicity and the resulting decrease in circulating androgen since T implantation prevented some of the changes in sperm proteins and motility. However, neither efferent duct ligation nor T implantation prevented the formation of sperm granulomas in the caput epididymidis, the distinct morphological alterations of the corpus epididymidis, the modification of certain sperm membrane proteins, or the decrease in the progressive motility and velocity of sperm following EDS treatment. Although we cannot prove these effects of EDS are due to a direct action on the epididymis, it is now clear that EDS has a distinct action on the epididymis which is unrelated to circulating T or testicular fluid.

Genital pathology of feral male goats

Genitalia from 1000 feral male goats derived from western Queensland and New South Wales were examined after slaughter at an abattoir and the prevalence of abnormalities determined. Ulcerative balanoposthitis, considered due to caprine herpesvirus infection, was observed in 11 animals (1.1%); acidophilic intranuclear inclusions were found in 7 of these. Other conditions included focal hypoplasia of seminiferous tubules in 2 bucks (0.2%), segmental aplasia of the epididymis (one buck, 0.1%), bulbourethral gland cysts with contained aggregations (33 bucks, 3.3%) and haemangiosarcoma of the bulbourethral gland in one animal. The low prevalence of several conditions such as spermatic granuloma, cryptorchidism, and testicular hypoplasia, was attributed largely to the fact that the bucks examined were horned so that the recognised association between genital abnormalities and polledness did not apply.

Laser-Assisted Vasectomy Reversal: Experience in 32 Patients

A Food and Drug Administration approved protocol using a microsurgical carbon dioxide laser to assist in vasectomy reversal was instituted in January 1987. Between January 1987 and December 1988 the procedure was performed on 32 patients, 31 of whom submitted sperm and were available to evaluate. Success rates for sperm in the ejaculate in patients who underwent vasectomy less than 10 years previously were excellent, approaching 95%. The pregnancy rate in this group was 35%. In patients whose vasectomy was performed more than 10 years before reversal the results were much poorer. The success rate for sperm in the ejaculate was only 36% and the pregnancy rate was only 9%.The advantage of laser-assisted vasectomy reversal is that it is a simpler technical procedure that requires considerably less time than a 2-layer microsurgical technique. There were no significant complications, sperm granuloma, or even significant swelling or hematoma in any patient operated upon. Laser-assisted vasectomy reversal is at least equal to conventional microsurgical techniques and definitely easier to perform surgically.

Benign Conditions of the External Genitalia

Benign mass lesions of the scrotum include spermatocele, hydrocele, varicocele, sperm granuloma after vasectomy, tuberculous masses, and epididymitis. A careful history and physical examination are paramount in making the diagnosis of a scrotal mass. Referral to a urologist is indicated for masses that do not transilluminate, are solid or fixed to the testicle, or for epididymitis that does not respond to antibiotics. Hydroceles associated with significant symptoms or with hernia and varicoceles with symptoms or associated infertility are also reasons for referral. After a sexual history is obtained, lesions of the anogenital area should be carefully inspected. Male partners of women with cervical dysplasia should be examined for evidence of human papillomavirus infection. Treatment of anogenital lesions resulting from a sexually transmitted disease involves both partners.

Immunological Status of Patients before and after Vasovasostomy as Determined by the Immunobead Antisperm Antibody Test

With the immunobead antisperm antibody test a prospective study was conducted to evaluate the immune status of 55 men before and after vasectomy reversal. A third of the vasectomy patients (19 of 55) had significant serum-sperm antibodies (20 per cent binding or more) detected by the indirect immunobead antisperm antibody test. Of 31 vasovasostomy patients 12 (38 per cent) had significant sperm-surface antibodies (20 per cent binding or more) by the direct immunobead antisperm antibody test. Preoperative serum assays correctly classified the antibody status of 69 per cent of the vasectomy patients. The immunological impact of spermatic granuloma formation, duration of vasal obstruction, patient age and presence of sperm in the vasal fluid at operation also were assessed. An inverse relationship between the proportion of antibody-bound sperm and the percentage of motile sperm in the ejaculate of vas reversal patients was found with videomicrographic semen analysis. The percentage motility was significantly lower among patients with greater quantities of sperm-surface antibodies. No other parameter of semen analysis showed this difference when compared for positive or negative immunobead antisperm antibody test results.

Pathologic changes in the accessory sex glands of rats treated with a sympatholytic hypotensive agent (losulazine).

Groups of 25 male Sprague-Dawley rats were treated by gastric intubation with either vehicle control (modified methylcellulose) or a suspension of losulazine at 4, 8, 16, or 32 mg/kg/day for 1 yr. Ten rats/group were killed after 6 months of treatment. Reversibility of drug-induced changes was evaluated in 8 rats/group treated for 6 months and held without treatment for 5 months. Daily clinical signs and weekly body weight changes were monitored. Seminal vesicle/coagulating glands were weighed in rats treated for 6 months. Gross and microscopic evaluation of the accessory sex glands (ampullary glands, prostate, seminal vesicles and coagulating glands) was conducted in all rats killed at 6 months, after the recovery period, and in rats that survived through the one-yr treatment period. Ptosis, somnolence, and fecal softening were detected in all groups treated with losulazine. There was a nonreversible body weight gain retardation in groups treated with 8 to 32 mg/kg/day of losulazine for 6 months or 1 yr. Absolute and relative weights of the seminal vesicle/coagulating glands of treated rats were not significantly different from those of control rats. The ventral prostate in a few rats in all treated groups had yellow to tan granular foci. Treatment, but not dose-related sperm granulomas or glandular impaction with inspissated secretion (formation of corpora amylacia) in the ampullary glands, enhanced cellular exudation into the acini of the ventral prostate, and impaction of the seminal vesicles with altered granular to globular secretion were found in rats treated with losulazine.(ABSTRACT TRUNCATED AT 250 WORDS)

Microrecanalization after vasectomy in man.

Previously spermatozoa in the semen of vasectomized men were reported in 62 of 63 specimens from 24 men 2 to 31 years postvasectomy (Freund and Couture, 1982). A morphologic basis and term, "microrecanalization," was proposed for this observation. Serial sections (5 mu at 200-mu intervals) of 40 specimens removed at vasovasostomy from 20 men (2 to 14 years postvasectomy) were examined and microcanals (small epithelial-lined channels) were demonstrated in 27 specimens from 18 men. In nine of the 27 specimens, spermatozoa or sperm heads were found within the microcanals. Microcanals occurred in smooth muscle, connective tissue and scar tissue, in each segment, testicular, central and abdominal, in the presence or absence of the vas deferens. Microcanal continuity was traced for 200 to 1140 microns by computerized image analysis. Microrecanalization is characterized by the absence of inflammation or sperm extravasation and is histologically distinct from vasitis nodes or sperm granuloma. Microrecanalization provides morphologic and physiologic bases for the protection of the testis and maintenance of spermatogenesis in man after vasectomy.