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Biomedical subjects

S J Silber

Publications and source records attributed to S J Silber.

At least 73 records · Page 4Linked to original sources
PubMed1981

Quantitative analysis of testicle biopsy: determination of partial obstruction and prediction of sperm count after surgery for obstruction.

Twenty-one male patients without ductal obstruction were studied prospectively by a simplified method of quantitative testicle biopsy. The mean number of mature spermatids per tubule in the testicle biopsy correlated closely with the sperm count in all 21 cases. Patients with less than 10,000,000 sperm/ml always had less than 20 mature spermatids per seminiferous tubule. Patients with more than 10,000,000 sperm/ml always had more than 20 mature spermatids per tubule. In azoospermic patients with epididymal obstruction, the sperm count after vasoepididymostomy could be predicted correctly by testicle biopsy. In severely oligospermic patients (less than 10,000,000 sperm/ml) the presence of more than 20 mature spermatids per tubule indicated partial epididymal obstruction.

Biopsy↗
PubMed1981

The intra-abdominal testes: microvascular autotransplantation.

Four patients with high intraperitoneal testes underwent autotransplantation to the scrotum by division of the spermatic vessels. On one side a microsurgical reanastomosis was performed. No reanastomosis was performed on the other side. Microsurgical reanastomosis prevented atrophy.

Adult↗
PubMed1980

Microsurgical reversal of female sterilization: the role of tubal length.

A group of 25 women who had undergone tubal sterilization by a variety of techniques underwent microsurgical reanastomosis. The length of tube remaining and the segments of tube involved were carefully noted preoperatively, but were not used as a basis for selection of patients. The only criterion utilized for selecting patients was the presence of fimbriae on at least one side. In all patients, anatomical patency was achieved at surgery. Normal intrauterine pregnancy was directly related to tubal length. Of seven patients who had less than 3 cm of tube, none achieved pregnancy. Of seven patients who had 3 to 4 cm of tube, three achieved a normal intrauterine pregnancy. Among 11 patients who had over 4 cm of tube, all 11 achieved a normal intrauterine pregnancy. No significant difference in pregnancy rate was noted in women who had short segmants of ampulla so long as total tubal length was adequate.

Fallopian Tubes↗
PubMed1980

Ejaculatory duct obstruction.

The diagnosis, long-range pathophysiology and surgical approach to ejaculatory duct obstruction are presented. Of 5 cases 3 had epididymal extravasation from long-term pressure buildup and secondary epididymal obstruction. This is similar to the epididymal findings after long-term vasectomy.

Adult↗
PubMed1980

Laparoscopy for cryptorchidism.

Laparoscopy is suggested as an accurate way to localize the non-palpable testicle or to diagnose anorchia without an abdominal exploration. From our early experience laparoscopy will aid greatly in the management of the intra-abdominal testicle.

Adult↗
PubMed1980

Vasoepididymostomy to the head of the epididymis: recovery of normal spermatozoal motility.

We previously reported a microsurgical technique for bypassing epididymal obstruction by performing a specific microanastomosis to the epididymal tubule. When obstruction was near the head of the epididymis, spermatozoal motility was always poor (0 to 1%) even though the numerical count was high. There are now over 1 1/2 years of follow-up on the first five patients who had a vasoepididymostomy performed in the proximal region (head) of the epididymis. None of these patients had more than 0 to 1% spermatozoal motility postoperatively despite counts of more than 50 million sperm/ml. However, within 1 1/2 to 2 years the spermatozoa of these patients eventually developed normal motility. This study verifies that in humans spermatozoa derived from the head of the epididymis are at first not capable of motility. However, after 1 or 2 years, these spermatozoa eventually recover normal motility. This unexpected finding sheds new light on epididymal physiology and offers some hope for men with proximal epididymal obstruction.

Adult↗
PubMed1979

Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal.

Twenty-eight men undergoing vasectomy reversal who were found to have no sperm in the proximal vas fluid on one or both sides underwent microscopic epididymal exploration. In 33 of 39 cases so explored, normal sperm were found in the epididymal fluid of the corpus, despite absence of sperm in the vas fluid. Epididymal histology distal to this site revealed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scanty fluid. It is concluded that persistent azoospermia after an accurate microscopic vasovasostomy results from the secondary epididymal obstruction induced by rupture of the epididymal duct related to the pressure increase after vasectomy.

Adult↗
PubMed1979

Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia.

The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.

Canada↗
PubMed1978

Transplantation of a human testis for anorchia.

One of two genetically identical twins (30 years old) had been born with two normal testes and the other with none. In the anorchic twin, preoperative serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were extremely high, and the serum testosterone level was extremely low. In the twin with two testes, preoperative serum FSH, LH, and testosterone levels were normal. After successful transplantation of a testis from the twin with two testes to the twin with no testes, using the microvascular technique, the recipient twin developed a normal serum testosterone level within 2 hours of surgery; his FSH and LH levels came down toward a normal range more slowly over the ensuing 4 weeks. The donor's FSH level became mildly elevated 2 days postoperatively but returned to normal by 3 months. Thereafter, serum FSH, LH, and testosterone levels remained persistently normal in both twins. In the donor, pre- and postoperative sperm counts were normal. Preoperatively the recipient's semen had no sperm, but postoperatively the sperm content has slowly increased to normal levels.

Cell Count↗
PubMed1978

Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule.

A new microscopic technique for vasoepididymostomy is described. Conventional approaches to epididymal obstruction rely on the formation of a fistulous tract after the walls of the vas deferens are grossly sutured to the outer tunic of the epididymis; such methods have a low success rate. With a direct and accurate end-to-end anastomosis of the inner lumen of the vas deferens specifically to the epididymal tubule there is a greater likelihood of normal patency. Furthermore, such an anastomosis can be performed at the lowest possible level of the epididymis, allowing a greater opportunity for sperm maturation.

Epididymis↗
PubMed1978

Vasectomy and its microsurgical reversal.

In our series the overall pregnancy rate after vasovasostomy in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of vas fluid on the testicular side of obstruction at the time of vasovasostomy. The three most important factors in our group influencing return of fertility after vasovasostomy were a meticulous microscopic technique for reconnection, the duration of time the vas deferens has been obstructed, and the presence or absence of a sperm granuloma at the site of vasectomy. The presence of a sperm granuloma at the site of vasectomy virtually ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy. If all three of these factors are favorable, vasectomy may be reversible for more patients.

Dilatation, Pathologic↗
PubMed1977

Sperm granuloma and reversibility of vasectomy.

Ninety-two consecutive patients who had undergone bilateral vasectomy 1 month to 28 years earlier were studied at the time of vasectomy reversal for sperm output, dilatation of the vas-deferens lumen, and sperm granuloma. Thirty-nine men had unilateral or bilateral sperm granuloma. The presence of of a sperm granuloma virtually assured normal sperm in the vas fluid no matter how long ago the vasectomy was performed. In the absence of a sperm granuloma, the interval since vasectomy had an important influence on the quality of vas fluid. The presence of a sperm granuloma was associated with significantly less dilatation of vas-deferens lumen at the testicular end. The site of the vasectomy and the amount of vas deferens removed did not influence sperm quality. A sperm granuloma on only one side resulted in normal spermatozoa in the vas fluid on that side, whereas the side without the sperm granuloma had abnormal spermatozoa or no spermatozoa in the vas fluid. It is concluded that when sperm granuloma follows vasectomy it vents the high pressure otherwise created by vasectomy and prevents disruption of sperm output in the vas fluid.

Adult↗