Vas Ligation Research Articles

V12-01 NEW BIPOLAR RADIOFREQUENCY SEALING TOOL FOR TRANSDERMAL VASECTOMY IN THE RABBIT MODEL: A PARADIGM SHIFT IN VASECTOMY TECHNIQUE?

You have accessJournal of UrologyCME1 May 2022V12-01 NEW BIPOLAR RADIOFREQUENCY SEALING TOOL FOR TRANSDERMAL VASECTOMY IN THE RABBIT MODEL: A PARADIGM SHIFT IN VASECTOMY TECHNIQUE? Gerard Henry, Ryan Griggs, Michel Labrecque, Joel Marmar, and Tariq Hakky Gerard HenryGerard Henry More articles by this author , Ryan GriggsRyan Griggs More articles by this author , Michel LabrecqueMichel Labrecque More articles by this author , Joel MarmarJoel Marmar More articles by this author , and Tariq HakkyTariq Hakky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bipolar Radiofrequency (RF) sealing tools have been shown to be successful in the treatment of many areas in the human body. RF has been utilized in the sealing of larger blood vessels and in nerve pain ablation in humans, showing good results for years. Urology has used RF ablation percutaneously for treating renal tumors for years. We evaluate the utilization of a new bipolar RF sealing tool for transdermal vasectomy in the rabbit model following AUA guidelines. METHODS: Two groups of 5 male New Zealand white rabbits were given IV sedation and local anesthetic and subsequent transdermal bilateral partial vasectomy using a high lateral scrotal approach. We isolated the vas with a novel insulated clamp fitting the U-shaped electrode of the sealing tool (Figure 1). In Group 1 (n=5), the device was set at 60W for 20s; however, this may differ across species. In the second group (n=5) the size of the U-shaped tool jaw was reduced and the device was set at 40 and 60W using thermal sensors. Impedance alarms shut off energy at a predetermined level. Wound healing, complications, survival, postmortem biopsies, and histology were evaluated. A doe rabbit was used with semen collections & semen analyses preformed on all male rabbits. RESULTS: We sacrificed 4 of the 5 (80%) of Group 1 rabbits due to poor wound healing secondary to excessive thermal damage. All 5/5 (100%) of Group 2 rabbits had good tissue healing and survived the procedure. The impedance alarm went off at about 5 seconds of sealing time and the device energy shut off in all Group 2 procedures. All rabbits had a negative semen analysis and on histology had occluded vas deferens. In bench top testing, we found that a 5 second interval is optimal for vas ligation. (Figure 1)Bench top testing revealed that thin short jaws (50 degree Celsius) created lower nearby tissue temperature than wide long jaws (77 degree Celsius). CONCLUSIONS: Transdermal bipolar RF sealing successfully occludes the vas deferens in rabbit vasectomy. The jaw size and sealing time using an impedance alarm system appear to be important for wound healing. This novel technique may decrease vasectomy time and morbidity. Canine studies are underway and analysis is pending. Further studies and FDA approval are needed before its application in humans. Source of Funding: Signati © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e967 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gerard Henry More articles by this author Ryan Griggs More articles by this author Michel Labrecque More articles by this author Joel Marmar More articles by this author Tariq Hakky More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impedance Rates for Novel Bipolar Radiofrequency Sealing Tool for Transdermal Vasectomy: A Rabbit Model

ABSTRACT Introduction Radiofrequency ablation functions by delivering thermal energy within a tissue resulting in coagulative necrosis and seals vessels. This tool has been successfully applied to other areas of the body. Objective We evaluate the safety and efficacy of radiofrequency ablation in transdermal vasectomy in rabbits. This was done by examining impedance rates through the tissue and its effect on wound healing. Methods Two groups of 5 male New Zealand white rabbits were given IV sedation and local anesthetic and subsequent transdermal bilateral partial vasectomy using a high lateral scrotal approach. We isolated the vas with a novel insulated clamp fitting the U-shape electrode of the sealing tool (Figure 1). All tissue layers were removed enbloc. In Group 1 (n=5), the device was set at 60 watts for 20 seconds. In the second group (n=5), the size of the U-shape electrode was reduced and the device was set at 40 and 60 watts using thermal sensors with impedance alarms to shut off if there was excessive energy. All 10 rabbits underwent a semen analysis, wound evaluation, post-mortem biopsies and histology was performed. Results We sacrificed 4 of the 5 (80%) of Group 1 rabbits due to poor wound healing due to excessive tissue damage, and all of Group 2 healed and survived. All rabbits had a negative semen analysis and on histology had occluded vas deferens. Impedance energy levels were variable and stopped at a predetermined level. We found that a 5 second interval is optimal for vas ligation. (Figure 1) Conclusions The novel transdermal bipolar radiofrequency ablation tool successfully occludes the vas deferens in the rabbit model. Impedance alarms with a predetermined Ohms level was reached at 5 seconds. This energy transfer rate and duration is paramount for wound healing. Future studies are needed before its application in humans. Disclosure Yes, this is sponsored by industry/sponsor: Signati Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Signati

New Bipolar Radiofrequency Sealing tool for Transdermal Vasectomy in the Rabbit Model: a Paradigm Shift in Vasectomy Technique?

ABSTRACT Introduction Bipolar Radiofrequency (RF) sealing tools have been shown to be successful in the treatment of many areas in the human body. RF has been utilized in the sealing of larger blood vessels and in nerve pain ablation in humans, showing good results for years. Urology has used RF ablation percutaneously for treating renal tumors for years. Objective We evaluate the utilization of a new bipolar RF sealing tool for transdermal vasectomy in the rabbit model. Methods Two groups of 5 male New Zealand white rabbits were given IV sedation and local anesthetic and subsequent transdermal bilateral vasectomy using a high lateral scrotal approach. We isolated the vas with a novel insulated clamp, fitting the U-shaped electrode of the sealing tool (Figure 1) around the clamp. In Group 1 (n=5), the device was set at 60 watts for 20 seconds. In the second group (n=5), the size of the U-shaped tool jaw was reduced and the device was set at 40 and 60 watts using impedance sensing to automatically shut off energy at a predetermined level. Wound healing, complications, survival, postmortem biopsies, and histology were evaluated. A doe rabbit was used with semen collections & semen analyses preformed on all male rabbits. Results We sacrificed 4 of the 5 (80%) of Group 1 rabbits due to poor wound healing due to excessive thermal damage. All 5/5 (100%) of Group 2 rabbits had good tissue healing and survived the procedure. At about 5 seconds of sealing, the impedance sensing automatically shut off power to the device in all Group 2 procedures. All rabbits had a negative semen analysis and on histology had occluded vas deferens. In bench top testing, we found that a 5 second interval is optimal for vas ligation. (Figure 1) Bench top testing revealed that thin short jaws created lower nearby tissue temperature (50 degree Celsius) than wide long jaws (77 degree Celsius). Conclusions Transdermal bipolar radiofrequency sealing successfully occludes the vas deferens in rabbit vasectomy. The jaw size and sealing time using an impedance alarm system appear to be important for wound healing. This novel technique may decrease vasectomy time and morbidity. Further studies are needed before its application in humans. Disclosure Yes, this is sponsored by industry/sponsor: Signati Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Signati

Effect of vas ligation on testicular sperm extraction results in nonobstructive azoospermic rats: Shaeer's lock-in technique.

This study evaluates the efficacy of vas ligation in enhancing sperm retrieval in nonobstructive azoospermia cases, by accumulating intratesticular spermatozoa. Fifty-six mature male rats with equally sized testes were included in this study. Forty-six were in the study group, and 10 were in the control group. Bilateral testicular fine needle aspiration was performed for all, to confirm presence of spermatozoa in all testes. Nonobstructive azoospermia was induced in all 56 rats, using Dienogest (40mg/kg) + Testosterone Undecanoate (25mg/kg) every month for three months. Monthly aspirations confirmed nonobstructive azoospermia from all rats, within the three months treatment. This was followed by unilateral vas ligation and was performed for 46 rats of the study group, with no ligation performed in the control group. After a further period of 90days (2 spermatogenic cycles) with the same medical treatment maintained, bilateral testicular sperm extraction was performed. Sperm retrieval was evaluated, comparing the outcome of vas-ligated testicles to the nonligated. Upon evaluation, spermatozoa were found in 14/46 of the vas-ligated testes (30.4%), compared to none of the nonligated (0/66), p=.0005. Ligation of the vas deferens in rats with nonobstructive azoospermia may enhance the results of sperm retrieval via sperm accumulation.

Fulguration of the lumen does not improve vasectomy sterilization rates

To assess the effect of adding lumen diathermy fulguration to our standard technique of vas ligation with polyglactin 910 (Vicryl(TM), Ethicon, Sommerville, NJ, USA) excision and fascial interposition, in an attempt to improve our sterilization rates. We previously reported the effect of changing suture material on vasectomy success rates; 3005 post-vasectomy semen analyses (PVSA) revealed a decrease in sterilization rates after surgery on changing from chromic catgut to polyglactin 910. We retrospectively reviewed PVSA undertaken for vasectomies performed by urological surgeons at the Mid-Yorkshire NHS Trust for 18 months from September 2005 to February 2007. There were 592 vasectomies in all; the age distribution of patients between the groups treated with the standard and new method was similar. Overall, 166 patients (28%) failed to provide two semen samples as instructed, and so were excluded from further analyses. Sterility was achieved in 367 patients (86%); a further 28 (7%) have indeterminate analyses to date, with one of the last two PVSAs showing sperm, with the PVSA of 32 (7%) patients showing persisting sperm. For the eight surgeons reviewed the sterility rates were broadly similar. The introduction of diathermy fulguration of the lumen has not improved vasectomy sterilization rates, with up to 14% having sperm on PVSA.

Vasography-Clinical and Experimental Investigations

In order to examine the effect of contrast mediums of different concentration and composition upon the vas, experiments in 90 rats were done. In comparison to three control groups of 10 animals each (surgery only, vas ligation only, saline injection) six contrast mediums caused a varying degree of damage to the vas deferens. The latter included irritation of the epithelium, inflammation, cellular infiltration, fibrosis of the wall, septum-formation and fenestration within the vas and actual obliteration. According to these experiments only hydrophilic contrast mediums of low concentration should be used in humans for vasography.

The ligation of the male reproductive organs and the role of the spermatic cyst.

The effects of ligation of the vas deferens, the corpus epididymis and the vasa efferentia on spermatozoa and testicular morphology were studied in sexually mature rats. Following the ligation of the vas deferens, headless and immotile spermatozoa were observed on the second day in the vas deferens. Decapitation occured in more than ninty per cent of the spermatozoa on the sixth day and the motility became almost zero. On the contrary, in the epididymis normal spermatozoa were observed for a relatively long period. Even three weeks after the vas ligation, more than ninty per cent of spermatozoa showed normal morphology. Spermatic cyst formation was observed so early as four days following ligation of the vas. By the third week cysts were observed in most rats, either unilaterally or bilaterally. In addition, ligation of the corpus epididymis resulted also in the formation of a spermatic cyst on the proximal site of the ligature. A strong correlation was observed between spermatic cyst formation and the occurrence of morphological changes in the testis, as well as the motility and the normality of spermatozoa. When the spermatic cyst was formed, the testis showed almost normal morphology for a long period as well as spermatozoa in the ductal system. When a spermatic cyst was not formed, degenerative changes took place promptly and abnormal spermatozoa were observed in the ductal system. These observations suggest that the seminiferous tubules may be very sensitivie to the increase in intratubular pressure and in such instances the spermatic cyst acts as a "shock absorber" to prevent the abnormal increase of pressure within the ductal system, especially the seminiferous tubules. In addition, the result suggests further that a need for caution and careful follow-up are necessary in the vasectomized man.

Endoscopic Treatment of Vesicovasal and Vesicoureteral Reflux in Infants With Persisting Mesonephric Duct

We present a minimally invasive endoscopic approach for the treatment of persisting mesonephric duct in male infants. Five male infants 2 to 8 months old were referred with a history of recurrent sepsis, epididymo-orchitis and anorectal malformation that was treated elsewhere with initial colostomy. All infants had edematous unilateral testes, fever and poor feeding. Urine and blood cultures yielded the same microorganisms. All infections occurred while the infants were on regimens of prophylactic antibiotics. Comprehensive urological evaluations confirmed ipsilateral renal agenesis, sacral hypoplasia (3 patients), high anorectal malformation, and vesicovasal and vesicoureteral reflux. All 5 infants underwent urethrocystoscopy under general anesthesia. The ectopic persisting mesonephric duct entered the bladder neck and proximal prostatic urethra. Injection of 0.4 to 0.7 ml Urocol, used as a bulking agent, was administered submucosally at the opening of the persisting mesonephric duct. In 1 patient the orifice of the anomalous duct was not found during urethrocystoscopy, and ipsilateral vas ligation by titanium clips was performed. The results in the remaining 4 patients were excellent, and no further episodes of epididymitis were observed during a mean followup of 30 months. The diagnosis of persisting mesonephric duct should be considered in a male child with anorectal anomalies and recurrent epididymo-orchitis, and can be confirmed by radiological studies and cystoscopy. Endoscopic treatment of this anomaly should be considered first line therapy in these patients. However, surgical intervention is mandatory for children not responding to the procedure.

Histopathological examination of both ipsilateral and contralateral testes with different obstructive models in prepubertal and adult rats.

To determine the histopathological changes in both the ipsilateral and contralateral testes of prepubertal and adult male rats 60 days after creating different obstructive models. Thirty-six prepubertal and 32 adult albino male rats were examined in three different obstructive models of the right testis. In group 1 the spermatic cord was ligated, in group 2 the ligation was between the caput epididymis and testis, and in group 3 the vas deferens was ligated. Sixty days after ligation both testes were removed and evaluated for testis diameter, mean seminiferous tubule diameter (MSTD), and degenerative, obstructive and inflammatory changes. The diameter of the obstructed right testis and MSTD were significantly greater in prepubertal rats but there was no apparent difference in adult rats. For obstructive changes, sloughing of germ cells in the prepubertal rats and germ cell absence in adult rats were significantly more common in group 3. The contralateral testis diameter and MSTD of group 3 was significantly greater only in prepubertal rats. Statistically significant values of obstructive change, e.g. sloughing of germ cells and apical vacuolation in Sertoli cells, were apparent in prepubertal rats, but tubular ectasis was the only statistically significant criterion of obstruction in adult rats. The testes are more susceptible to obstruction of the vas deferens in prepubertal than in adults rats, resulting in increased hydrostatic pressure and oedema of both the ipsilateral and contralateral testes, which might be caused by collateral circulation and rat testicular microcirculation, with a rhythmic pattern of arteriolar dilatation and constriction (vasomotion). Although the presence of oedema and high hydrostatic pressure was not prominent in adults, formation of spermatic granulomas and absence or sloughing of germ cells in the obstructed and contralateral testes reflect the early effects of vas ligation on spermatogenesis in adulthood.

Effects of Abdominal Location and Epididymal or Vasal Obstructions either Individually or in Association on Ipsilateral and Contralateral Testes

Objective: An experimental study was conducted to evaluate the damages in ipsilateral and contralateral testes in individual or associated presences of abdominal location and vasal or epididymal obstructions. Methods: Six groups each consisting of 8 rats were established. The groups included sham operation, ligation of the vas deferens, detachment of the epididymis from testis, abdominal placement of the testis, abdominal placement of the testis with vas deferens ligation, and abdominal placement of the testis with detachment of epididymis from testis. After 30 days, bilateral orchidectomy was performed. Mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were obtained for each testis. Relative proportions of haploid, diploid and tetraploid cells were determined by DNA flow cytometry. MSTD, MTBS and the proportions of haploid cells were compared through one–way analysis of variance. Results: While vas deferens ligation has diminished MSTD only in the contralateral testes, abdominal testis and detachment of epididymis have diminished MSTD in both ipsilateral and contralateral testes. MTBS were depressed only in the ipsilateral testes in groups of abdominal testis, vas deferens ligation and detachment of epdidymis. However, ratios of haploid DNA were depressed in both ipsilateral and contralateral testes. Abdominal testis together with vas ligation or detachment of epididymis has further depressed the ratios of haploid DNA in both ipsilateral and contralateral testes. Conclusion: Compared to their individual presence, the associated presence of abdominal testis and vasal or epididymal obstructions may augment the damages encountered within the ipsilateral and contralateral testes.

Most Vasectomies Are Performed in Urology Practices by Physicians Using Ligation and Local Anesthesia

AVSC International and the US Centers for Disease Control and Prevention conducted a survey of physician practices in urology (702) general surgery (660) and family medicine (323) throughout the US to examine vasectomy practices. In 1991 the vasectomy rate was 10.3 vasectomies/1000 men with the midwest having the highest vasectomy rate (14.5/1000). Urologists performed most vasectomies (72%) followed by family physicians (15%) and general surgeons (13%). Among the 702 urology practices 94% performed vasectomies. 29% of general surgery practices and 18% of family practice physicians performed them. In 43% of urology practices more than 50 vasectomies per year were conducted. The mean number of vasectomies in urology and family practices was greatest in the midwest (113 and 26 respectively). The mean number of vasectomies in general surgery practices was greatest in the northeast and the west (26 each). Physicians offices were the most common setting for the procedure (77%) followed by outpatient hospital clinics (19%) and family planning clinics free-standing surgical centers and health maintenance organizations (4%). Regardless of physician type physicians tended to perform vasectomies in their office. They used local anesthesia for 99% of all vasectomies (76% local anesthesia alone or 23% with sedation). General anesthesia was practiced more often in general surgery practices (5% vs. 1% for urology practices and 0 for family practice practices). No practice in the west used general anesthesia. Vas ligation was the most frequent method of performing the vasectomy (39% alone and 22% with cautery). Cautery alone comprised 20% of vasectomies. Clips were used for only 11% of vasectomies. Yet urology textbooks advise cautery or clips over vas ligation. These findings indicate a need for case control studies to examine the effectiveness of ligation in comparison with other vas occlusion methods.

Vasal sterilization in China

Vasal sterilization has become the most popular method of contraception in many countries since the 1960's. In China, an estimated 30 million men have undergone voluntary sterilization. There have been two major developments in vasectomy technique, the no-scalpel method and the percutaneous chemical vas occlusion. These methods have significantly increased the acceptability of male sterilization in some cultures since no incisions in the skin are required. The effective rate is over 98% for both methods. The clients experience less pain, fewer complications and more rapid recovery. Epidemiological studies of large numbers of volunteers receiving no-scalpel or chemical vas occlusion procedures have resulted in a clearer picture of their safety, effectiveness, simplicity and economy. Meanwhile, some promising reversible vasal sterilization techniques have also been studied.

Fate of α-l,4-Glucosidases and Cathepsin D in the Rat Epididymis after Vasectomy

Short-term vasectomy was studied in adult male rats in order to ascertain whether cytosolic or lysosomal hydrolases were differently affected 100 days after vas ligation. The secretory form of alpha-1,4-glucosidase remained unchanged while the lysosomal form of the enzyme and also cathepsin D increased in the cytosol of both caput and cauda epididymis. This set of data demonstrates for the first time that a triggering mechanism which stimulates lysosomal activity is present all along the rat epididymis. Disposal of the continuous influx of spermatozoa from the testis could therefore require both an active and a passive process.

Microsurgical vasovasostomy for reversal of elective bilateral segmental vasectomy.

Microsurgical vasovasostomy for the reversal of elective bilateral segmental vasectomy (vasectomy, vas ligation) was done in 57 patients (61 operations) between May 1977 and March 1984. The length of time between elective segmental vasectomy and subsequent vasovasostomy ranged from 12 to 216 months; the longest period between vasectomy and vasovasostomy resulting in a subsequent pregnancy was 108 months. The patency rate was 83%, with 51% of these patients fathering one or more children (overall pregnancy rate of 41%). Unlike previous studies, ours showed no positive correlation between the presence of postvasectomy sperm granulomas and either patency or pregnancy rate after microsurgical vasovasostomy. The major factor that seemed to affect the success of the procedure was the number of years between vas ligation and vasovasostomy.

Prophylaxis of postoperative epididymitis: Vasectomy or vas ligation?

Preoperative vasectomy for the prevention of postoperative epididymitis in 103 cases is compared to preoperative vas ligation in 132 cases performed by the same surgical team. Both methods showed good results. However, vas ligation is easier to perform and seems to have less complications. The vas ligation procedure is discussed.

Recanalization Rate Following Methods of Vasectomy Using Interposition of Fascial Sheath of Vas Deferens

A small but definite recanalization rate has followed the vas ligation method of partial vasectomy for sterilization. Interposition of the fascial sheath between the divided ends of the vas reduced the recanalization rate to 0. Fulguration of the lumen of the cut vas ends was used but was not the significant factor in this zero recanalization rate.

Immunologic Implications of Vasectomy: II. Serum-Mediated Immunity

The development of sperm-specific, cell-mediated immunity in postvasectomized rats was determined using 3 different types of assays: footpad swelling response to injected syngeneic spermatozoa; radioactive release from chromium labeled spermatozoa; and release of macrophage migration inhibition factor from lymphocytes responding to spermatozoa. 30 male rats underwent vasectomy with 1 of the following in groups of 10: 1) ligation of the vas deferens; 2) vasectomy without ligation of the vas deferens; or 3) sham vasectomy. Assays for cell-mediated immunity were performed 90 days postvasectomy. Cell-mediated immunity was present only in rats without ligation of the vas deferens. The swelling response to spermatozoa in Group 2 rats was statistically significant (p less than .01). A lymphocyte cell-mediated release of chromium from labeled spermatozoa was highly significant when Group 2 animals were the source of spleen cells (p less than .0005). Macrophage migration inhibition was significant (p less than .01) in supernatants taken from cultures of syngeneic spermatozoa with spleen cells of Group 2 rats, vasectomized without vas ligation. Possible reasons for these results were presented.

Bilateral vas ligation: Sperm antibodies

Circulating sperm-agglutinating antibodies were demonstrated in 7 of 18 postvasectomized men three years following the procedure. Sperm-agglutinating activity of the serum peaked at 18 months after bilateral vas ligation. Sperm-immobilizing antibodies were present in 6 of 18 men 12 months postvasectomy, but only one remained positive thereafter, at a lower titer. Sperm antibody activity in the serum is initiated within 7 to 11 days following bilateral vas ligation. Immunoglobulin levels in these sera did not appreciably change despite the presence of sperm antibody activity. Seminal plasma immunoglobulin levels examined from samples submitted by nine men six weeks, six months, and twelve months after bilateral vas ligation remained relatively constant.

Comparison of ligation and fulguration methods

Bilateral vasectomy for sterilization using the electrofulguration technique has resulted in no early recanalization of the vas deferens, whereas recanalization did follow the vas ligation method. The operative discomfort and morbid state with minor wound complications were higher with the fulguration method than with the ligation method.

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.