Sperm Granuloma Research Articles

Sutureless Vasectomy, an Improved Technique: 1300 Cases Performed Without Failure

Thirteen hundred bilateral, partial vasectomies have been performed for sterilization, without a failure. The procedure utilizes (1) a small, single incision; (2) no sutures; (3) cautery of each vas deferens lumen with a hand-held, battery-operated, disposable, hot-wire cautery; and (4) sealing of the proximal vas deferens in its sheath with a single tantalum clip. No spermatic granulomas were noted using this technique.

Some gross observations of the epididymides following vasectomy: a clinical study

In 114 vasectomized men, 220 epididymides were grossly examined during vasovasostomy. Fullness, distention, turgidity, thickening, induration, and other gross changes of the epididymides, including the formation of cystic spermatic granuloma, or spermatocele, indicated inadequate removal of spermatozoa and testicular fluid from the sequestrated proximal seminal ducts and the epididymis. Further studies are necessary to determine whether the epididymal changes following vasectomy have any effect on sperm morphology and sperm physiology. The information obtained from these studies possibly may explain the poor pregnancy rates in the spouses of successfully vasanastomosed patients.

Vasectomy without complication

In a four-year period 500 outpatient vasectomies were performed by the author. Bilateral scrotal incisions were used in all cases as were metal clips to occlude the vas deferens. Operating time rarely exceeded fifteen minutes. No failures and no sperm granulomas were encountered. Complications were rare and included a single scrotal hematoma and six minor infections. Unilateral absence of the vas deferens was noted in 2 patients. The technique to be described is a simple, complication-free method of vasectomy.[/b] The Doctor's Office Building 300 Mount Auburn Street Cambridge, Massachusetts 02138

Suppression of sperm granulomas in vasectomized rats by local heating of the testis.

Local application of heat to the testis of mature rats shortly before vasectomy supressed the formation of sperm granulomas. Thirty days after surgery few spermatozoa were seen in the caput or corpus epididymidis and the incidence and size of sperm granulomas were markedly reduced. Autopsy findings 61 days after exposure showed that the lesions had been suppressed although the testis had resumed active spermatogenesis and spermatozoa were seen throughout the excurrent duct. Histological studies 31 days after exposure showed that numerous macrophages had invaded the sperm granulomas and the duct lumen of the cauda epididymidis of the locally heated vasectomized rats. However, removal of spermatozoa in the cauda epididymidis by resorption or phagocytosis was slow and it is doubtful that these processes operate effectively in the vasectomized rat. Recovery of the testisat between 31 and 121 days after local heating resulted in the formation of new lesionswhich were, however, only halfthe sizeof those found in the non-heated vasectomized ratsautopsied 120 days postoperatively.Local heating of the testisdid not impair normal function of the Leydig cellssince plasma testosteronelevelswere comparable in heated-vasectomized and control rats. On the basisof these observations,localapplicationof heat to the testismay be a potentially safemethod of reducing the incidence of sperm granulomas and theirimmunological consequences.

Fine structure of the rabbit testis after vasectomy.

The testes of adult male rabbits were studied with the light and electron microscopes at intervals of up to 9 months after vasectomy or a sham operation. No changes were detected in any rabbits killed at intervals between 2 weeks and 4 months after vasectomy or in 1 of 2 rabbits prepared 6 months after vasectomy. In one rabbit killed 6 months after operation spermatogenesis was severely depressed and a spermatic granuloma was present near the epididymis. All 3 rabbits killed 9 months after vasectomy exhibited a greater than normal number of multinucleate spermatids, and this condition was most pronounced in one rabbit in which the epididymis and vas deferens were the most greatly distended of all the vasectomized animals. No changes were observed in animals that received a sham operation.

Fine structure of the rabbit epididymis and vas deferens after vasectomy.

Adult male rabbits were subjected to either bilateral vasectomy or a bilateral sham operation. Several portions of the epididymis and vas deferens were studied with the light and electron microscopes at intervals up to 9 months after operation. In vasectomized rabbits, the epididymis and proximal vas deferent were distended with sperm and expanded progressively from 2 weeks through 4 months after vasectomy. This expansion continued in one rabbit killed at 6 months and in one killed 9 months after vasectomy. However, in the remaining 3 rabbits killed 6 or 9 months after vasectomy, the epididymidis and vas deferens were less distended than in other vasectomized animals, and in 2 of these there was evidence that sperm escaped the male duct system and underwent phagocytosis in a spermatic granuloma in the surrounding connective tissue. Despite the distention, the epithelium of the epididymis and vas deferens of vasectomized rabbits remained columnar. The epithelium also continued to be functionally active as indicated by the persistence of the characteristic complement of cellular organdIes, including vacuoles and lysosomes thought to be involved in absorption and smooth endoplasmic reticulum that may be involved in secretion. The epithelium of the cauda epididymidis and proximal part of the vas deferens in both vasectomized and sham-operated animals fixed 2 to 6 months after operation was highly folded and had many apical cytoplasmic projections. The origin of this change is unknown, but it may be related to seasonal variations in activity of the epithelium.

Spontaneous Reanastomosis of the Vas Deferens after Surgery: A Case Report

Spontaneous reanastomosis of the vas on one side in a 40-year-old man was caused by a sperm granuloma. Leaking spermatozoa bridged the gap between the cut ends; this was followed by epithelial canalization. From review of the literature it was concluded that the best preventive measure is light fulguration of the cut ends and then their separation by covering one cut end by its faschial sheath.

Spermatic granulomas of epididymis

This report is of a patient with spontaneous spermatic granuloma of the epididymis, an uncommon condition to occur without antecedent surgery, trauma, or clinical infection.

Intratubular hydrostatic pressure in testis and epididymis before and after vasectomy.

A method is described for the measurement of intratubular hydrostatic pressure in the testis, caput epididymidis, and cauda epididymidis of the golden hamster. Pressures in these locations in normal animals ranged from 3 to 6 cmH2O. Mean pressure in the tubules of the caput was significantly higher than that in the seminiferous tubules (P smaller than 0.05) and in the proximal caudal tubules (P smaller than 0.02). There was a small, significant increase in pressure from the proximal cauda to the distal cauda (P smaller than 0.04). Two weeks after vasectomy, the mean pressure in the seminiferous tubules of 3.3 cmH2O was significantly lower (P smaller than 0.004) than the mean pressure in the normal seminiferous tubules of 4.4 cmH2O. Pressures in the cauda at 2 wk of 10-18 cmH2O were significantly greater than normal (P smaller than 0.0005) and reflected the accumulation of sperm and fluid. The high incidence of spermatic granuloma formation and/or rupture of the epididymis observed after vasectomy emphasized that there are definite limits to both distensibility and reabsorptive capacity of the epididymis in some species. Pressures at 1 mo after vasectomy were similar to those at 2 wk in animals that were still obstructed and comparable to normal in animals with granulomas and/or large epididymal leaks. Testicular weight was slightly but significantly decreased 2 wk after vasectomy. At 4 wk, there was no detectable effect of vasectomy on the weights of the testes.

Transplacental effects of diethylstilbestrol on the genital tract of hamster offspring

Summary The effect of diethylstilbestrol (DES) was investigated in Syrian golden hamster progeny exposed during the terminal stages of gestation. Eleven pregnant hamsters were treated with 40 or 20 mg/kg body weight (b.w.) of DES. This treatment led to hyperplastic and neoplastic lesions in the reproductive system of most female progeny and was associated with continuous estrogenic stimulation. Seventy per cent of the male progeny developed spermatic granulomas of the epididymis and testis. The incidence and severity of these lesions were proportional to the dose of DES.

The Effects of Immunosuppression on Sperm Granulomas in Vasectomized Rats

The relationship between automimmunity and sperm granulomas was investigated by histological study of these lesions in immunosuppressed and nonimmunosuppressed rats. To produce immunosuppression the thymus-dependent lymphocyte component of cell-mediated immunity was reduced by the administration of antilymphocytic serum. In others further suppression of thymus-dependent lymphocyte response was sought by neonatal thymectomy plus the serum. In another group the alkylating agent cyclophosphamide (cytoxan) was used 40 mg/kg (lethal dose 80) to block dexocyribonucleic acid synthesis in rapidly dividing precursors of immunocompenten cells. Proof of immunosuppression was shown by the ability of the treated animals to accept allogeneic skin grafts for 21 days. Vasectomies were done leaving the ends of the severed vas deferens unligated. All rats were sacrificed 21 days after vasectomy. Average weights of sperm granuloma were increased in the immunosuppressed animals. Sections of testicular tissue and of granulomas were examined histologically. Spermatogenesis had continued. Testicular and epididymal histology remained normal. The granulomas were composed of a central core of packed unabsorbed spermatozoa surrounded by a paracentral core of histiocytic cells and a peripheral fibrous zone. Polymorphonuclear leukocytes were present in the paracentral zone. Lymphocytes and plasma cells predominated in the fibrous zone. The immunosuppression had no effect on the formation of sperm granulomas suggesting that sperm granuloms do not indicate autoimmunity. Nor are they the result of an inflammatory process brought about primarily by autoimmune phenomena.

One Thousand Vasectomies

The author reviewed a series of 223 of his patients who underwent bilateral vasectomy. The method involved resecting 2.5 cm of the vas on each side doubling back each end for 1.5 cm and double ligating the ends with nonabsorbable sutures. The ends are then replaced in the anatomical position. No sperm granulomas hematomas or scrotal infection have been noted using this technique. However the operation must be done under general anesthetic and there is more postoperative pain. By the fourth month after the operation 91% of the patients produced 2 specimens that were azoospermic. The method may be more efficient in the long run.

A New Method for Suppressing Sperm Granuloma Formation in the Vasectomized Rat

In the authors experience sperm grnaulomas invariably occured after vasectomy in rats and in this study an attempt was made to suppress this formation by testosterone implants designed to suppress spermatogenesis. Mature male sprogue-Dautey rats were used. The incidence and size of these grnaulomas was markedly reduced or eliminated by suppression of spermatogenesis through subcutaneous implants of testosterone in silastic capsules. Implants did not alter the size of the ventral prostate or the seminal vesicles. However testicular weight was reduced by 52% and epididymal weight was reduced by 38%. Spermatogenesis was markedly reduced. The significance of sperm granulomas associated with vasectomy in men is discussed.

Spermatic granuloma of the epididymis in rats treated with guanethidine.

Spermatic granuloma of the epididymis in rats treated with guanethidine.

Spermatic Granuloma: The Complication of Vasectomy

Spermatic granuloma is known to be the most common postoperative complication of vasectomy whether done to prevent epididymitis or for sterilization. However it is seldom diagnosed. Results from studying 66 cases of histologically confirmed spermatic granulomas occurring from 3 weeks to 25 years after vasectomy are presented. Spermatic granuloma takes place in 15% of the vasectomy cases. It is an inflammatory reaction to the extravasation of sperm either from the vas or within the epididymis. Granuloma of the vas occurs when the proximal end of the vas is inadequately obstructed. It is particularly common when ligatures are used. Granuloma of the epididymis is seen less frequently but may occur from even slight trauma to the epididymiss. Pain sometimes severe often requires that the granuloma be excised but a symptomatic granuloma may also subside spontaneously. The granuloma may be completely asymptomatic a common finding at vasovasostomy. Spermatic granuloma is the means by which spontaneous reanastomosis of the vas occurs. Conversely it may cause obstruction and thereby prevent successful vasosvasostomy. Autoimmunity to spermatozoa may also result from a granuloma.

Sterility in Male Animals Induced by Injection of Chemical Agents into the Vas Deferens

This study was undertaken to develop a simple non-surgical technic for achieving male sterility. The method induces obstruction in the vas deferens by injecting sclerosing chemical agents through the skin of the scrotum directly into the vas. Previous success in rats using 95% ethanol have been reported. This sutdy used 95% ethanol, 10% silver nitrate, 36% acetic acid, 3.6% formaldehyde, 3% sodium tetradecyl sulfate, 5% sodium morrhuate, 5% potassium permanganate, 3.6% formaldehyde in 90% ethanol, and for controls .9% sodium chloride. 25 or 50 mcl of the agent being tested was injected into each vas deferens of mature Sprague-Dawley rats. 2 weeks after treatment the rats were exposed to continuous mating. All of the rats treated with ethanol, silver nitrate, acetic acid, formaldehyde, and sodium tetradecyl sulfate have remained sterile for 8 months. 33% of those treated with potassium permanganate and 67% of those treated with sodium morrhuate have remained fertile. When the experiment was repeated in dogs using 95% ethanol, 10% silver nitrate, or 3.6% formaldehyde in 90% ethanol (100 or 500 mcl injected through the skin of the scrotum) the same obstructing sclerosis was found and a reduction in size of the vas was visible for approximately 2 cm. No sperm granulomas were found either grossly or microscopically. The method has not be used in humans but injections of methylene blue dye in alcohol have been made in several human autopsy specimens. The dye was contained within the sheath of the vas and penetrated the full thickness of the wall of the vas. The method is believed to be suitable for humans, would avoid post-surgical hemorrhage and infection, would require less equipment, and more rapid accomplishment and lower cost would follow if paramedical personnel could be taught the procudre in less developed countries for mass voluntary sterilizations. The results appear to be permanent. Surgical reversibility has not be determined.

Sperm granulomas: an adverse effect of vasectomy.

This study performed at The Johns Hopkins medical institutions in Baltimore was the first long-term research concerning the incidence and mechanism of formation of sperm granulomas in rats following vas ligation. Both prepubertal and adult male rats were used in the experiments. Observation of more than 100 vasectomized rats showed sperm granuloma formation invariably occurs after vasectomy. Experimental results tended to eliminate the possibilities that leakage of sperm at the operation or suture material was a predisposing factor in granuloma formation. 6 months following vasectomy the average weight of a granuloma was .3-.7 gm. A typical lesion at this time contained massive accumulations of intact spermatozoa; thus it is thought that after vasectomy sperm are incompletely reabsorbed by the epididymis. At 6 months a typical granuloma contained 20-200 times the number of sperm in a single ejaculate of the rat. It was noted that size of the granulomas could eventually decrease with time. The typical life of an area of granulomatous inflammation began with an accumulation of large masses of sperm bordered by a rim of epithelioid histiocytes which was rimmed by a perivascular accumulation of round cells. The whole lesion was limited by a fibrous capsule. Then the lesion seemed to progress to a pyogenic granuloma many polymorphonuclear neutrophils moving into the sperm mass. The central mass was destroyed and histiocytic response with active phagocytosis of sperm was more pronounced. A classical granuloma resulted a smaller lesion with large numbers of epithelioid histiocytes with Langhans giant cells. The reabsorption of sperm in granuloma formation may trigger alterations in the animals immunology. Sperm are known as strong autoantigens.

A Review of Information Relevant to Vasectomy Counselors

Aspects of vasectomy are discussed in a review of information relevant to vasectomy counselors. The procedure of vasectomy is outlined and complications such as ecchymoses hematomas postoperative epididymitis spermatic granuloma of the epididymis and obstruction in the epidiymis are described and incidence noted. Vasovasostomy has been possible with complete recovery of function. Improved surgical procedure may increase reversibility of vasectomy. Antibody production in response to reabsorption of spermatozoa may cause infertility but research has just been initiated. It is suggested that vasectomy be regarded as a permanent measure. Psychosocial aspects of vasectomy show conflicting results with some adjustment problems noted. It is suggested that the most threatening aspects of vasectomy are resolved by the patient in 4 years. Derogatory cultural attitudes toward vasectomy studied in 1967 were reported among a group of college students and Protestant churchgoers. Attitudes may have changed in the last 5 years. Laws in the United States against voluntary sterility are virtually nonexistent. In 1927 the United States Supreme Court ruled supporting the constitutionality of a properly safeguarded compulsory sterilization law as a social measure.

The ultrastructural pathology of the rat epididymis after administration of -chlorhydrin (U-5897). I. Effects of a single high dose.

AbstractThe ultrastructural pathology of the initial segment of the rat caput epididymidis was examined after oral administration of a single high dose of the antifertility compound α‐chlorhydrin (U‐5897) at time intervals ranging from two hours to nine days after treatment. At doses in excess of 30 mg/kg this compound produces a lesion specifically localized in the initial segment of the epididymis characterized by sloughing of the epithelium, which leads to obstruction of the lumen of the epididymal duct, spermatocoel and sperm granuloma formation and an ultimate occlusive fibrosis. In rats fed 140 mg/kg of U‐5897 the first effects can be seen as early as two hours after treatment. Within 48 hours after treatment, the lumen of the greater part of the initial segment is filled with degenerating cells and debris which block further passage of sperm along the duct. The present study provides insight into the nature of the early events in the evolution of this epididymal lesion. Possible mechanisms of action of α‐chlorhydrin are discussed.

Technique of vasectomy.

In a vasectomy method reported as successful in 700 cases and 80 percent reversible the vas deferens is not resected. The cut ends of the vas are fugurized and one cut end covered with the fascial sheath of the vas. Ligatures are not recommended because they often cut into the lumen of the vas inviting leakage of spermatozoa spermatic granuloma and possible recanalization. Semen analysis should begin after the tenth ejaculation.