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Response of the mouse epididymal duct to the disappearance and reappearance of spermatozoa induced by temporal cryptorchidism.

Cryptorchid surgery to move the testis and epididymis to the abdomen was performed in mice of 60 days of age; one week later the mice were subjected to further surgery to reposition the organs in the scrotum. The mice were sacrificed at 1 week intervals until 11 weeks after the initial operation. After the first operation, spermatozoa in the epididymal duct rapidly disappeared and were almost absent until the 4th week. Then spermatozoa appeared again, increased, and reached normal numbers by 10 weeks. With the disappearance of the spermatozoa, a PAS-positive material, which is believed to be secreted in the middle part of the head of the epididymal duct (ABE et al., 1982), was accumulated in the epididymal duct in the body and tail of the epididymis, and PAS-positive inclusions appeared in the principal cells of the duct in the body 2 weeks after the first operation. The inclusions developed in size and number during the aspermia period, then decreased in number with the reappearance of spermatozoa from the 5th week to ultimately disappear by 10 weeks after the first operation. We have previously demonstrated that such inclusions appear also after efferent duct ligation, which interrupts the flow of spermatozoa and testicular fluid into the epididymal duct (ABE et al., 1982). Both present and previous findings indicate that the appearance of PAS-positive inclusions depends on the absence of spermatozoa in the epididymal duct irrespective of the presence of the testicular fluid in the duct. It is suggested that the PAS-positive material is utilized by spermatozoa and, in the absence of spermatozoa, is accumulated in the lumen and ingested by the principal cells of the epididymal duct in the body of the epididymis.

Animals↗

Epididymal and testicular sperm for intracytoplasmic sperm injection in the treatment of obstructive azoospermia.

BACKGROUND: The possibility of treating male infertility because of obstructive azoospermia has been poor, but intracytoplasmic sperm injection (ICSI) has given this type of infertility sufferer a new option. MATERIAL AND METHODS: In this study 13 couples with obstructive azoospermia were treated in a total of 19 stimulated IVF cycles. The men were between 27 and 45 (mean 33) years of age. Their partners, 24-39 (mean 31) years of age were treated according to routine IVF procedures, i.e. down regulation with buserelin followed by hyperstimulation with urofollitropin. Fertilization was obtained by ICSI. Two embryos were transferred on day two after the ovum pick up. Sperm were retrieved through microsurgical epididymal aspiration (MESA) in four cycles, percutaneous epididymal sperm aspiration (PESA) in three cycles and through testicular sperm extraction (TESE) in 12 cycles. RESULTS: The overall fertilization rate was 68%, with a cleavage rate of 82%.The fertilization rate was equal (68%) with epididymal and testicular sperm and the cleavage rate was 87%) and 80%, respectively. Embryos were obtained for embryo transfer (ET) in all cases and five pregnancies (one twin pregnancy) were established (26% per ET), three using epididymal sperm and two using testicular sperm. CONCLUSION: Infertility due to obstructive azoospermia can successfully be treated with epididymal sperm and ICSI. When epididymal sperm cannot be found sperm extracted from a testicular biopsy can be used. PESA and TESE are quicker and easier alternatives to MESA and can be performed on an outpatient basis with local anesthesia.

Adult↗

Heparin-induced nuclei decondensation of mammalian epididymal spermatozoa.

Decondensation of mammalian epididymal spermatozoa nuclei has been induced by exposure of intact spermatozoa to heparin, including those species in which ejaculated sperm were not susceptible to this treatment. This process occurred in the absence of any disulfide bond cleaving reactant. Swelling of caput epididymal spermatozoa nuclei commenced about 30 min after the addition of heparin, reaching 88% in rat, 33% in rabbit, 26% in pig, and 62% in bull of swelled nuclei after 6 hr of incubation at 37 degrees C with 5000 USP of heparin per ml. Corpus epididymal spermatozoa nuclei of rat and rabbit underwent decondensation at 50 degrees C reaching 24% and 22% of swelled nuclei, respectively, after 6 hr of incubation. The nuclei of the sperm cells of pig and bull from this epididymal region remained highly condensed as well as the nuclei of the cauda epididymal spermatozoa of all the species assayed. Electron microscope observations of the caput epididymal spermatozoa nuclei treated with heparin revealed that the chromatin is organized into nuclear bodies joined by a network of cross-linked and branched chromatin fibers in the species studied.

Animals↗

Fresh and frozen epididymal sperm yield comparable pregnancy rates for intracytoplasmic sperm injection.

To determine if the use of fresh epididymal sperm is superior to frozen-thawed epididymal sperm for intracytoplasmic sperm injection, the authors reviewed the charts on all couples undergoing intracytoplasmic sperm injection at an academic center, using microsurgically aspirated epididymal sperm. Forty-nine couples undergoing intracytoplasmic sperm injection for male factor infertility, due to congenital absence of vas deferens or irreparable post-testicular obstruction were studied. The following parameters were measured: (1) fertilization rate per oocyte injected (two pronuclei at 24 h), (2) chemical pregnancy rate (two consecutively elevated serum b-hCG levels, and (3) clinical pregnancy rate (sonographic identification of fetal heart rate). Fertilization rates were 51 and 41%, chemical pregnancy rates were 27 and 30%, and clinical pregnancy rates were 19 and 27% in the fresh epididymal compared to the frozen epididymal sperm. This study shows no significant difference in outcomes using fresh or frozen epididymal sperm for intracytoplasmic sperm injection. Frozen-thawed sperm guarantees availability of sperm prior to oocyte retrieval.

Adult↗

Posttesticular antifertility action of triptolide in the male rat: evidence for severe impairment of cauda epididymal sperm ultrastructure.

A variety of active diterpene epoxides, including the triptolide (isolated from Tripterygium wilfordii) have been reported to cause infertility in male rats. Previously, we showed that oral administration of triptolide at a dosage of 100 microg/kg per body weight for 70 days completely inhibited fertility in male rats, with little or no demonstrable detrimental effect on spermatogenesis and Leydig cell function as determined by testicular light microscopic appearance and serum and intratesticular testosterone levels. Despite the apparent absence of effects on the testes, cauda epididymal sperm were abnormal, with complete cessation of sperm motility and some reduction in sperm numbers. This study was undertaken to provide additional insight into the subcellular sites and possible mechanisms of action of this compound using ultrastructural analysis of the testes and epididymidis. The most striking effect of triptolide treatment was observed in sperm in the epididymis. In rats rendered infertile with 100 microg/kg per body weight of triptolide daily for 70 days, virtually all cauda epididymal sperm exhibited complete absence of plasma membrane over the entire middle and principal piece, premature decondensation of the nuclei, and disorganization of the mitochondrial sheath with many vacuolated mitochondria. No ultrastructural differences in the epididymal epithelium were observed between control and triptolide-treated rats. The testes appeared to be mildly affected after triptolide treatment but exhibited only subtle ultrastructural defects in the germ cells. The findings of severe impairment of cauda epididymal sperm ultrastructure, along with minimal discernible abnormalities in the fine structural cytology of the testes, further suggest that the site of action of this compound is posttesticular and may be confined to the cauda epididymal sperm. However, we cannot rule out an effect of triptolide that occurs during germ cell maturation but is delayed in its manifestation or triggered at the rete testis and epididymal level.

Animals↗

[Epididymal sperm aspiration for obstructive azoospermia].

Epididymal sperm aspiration technique combined with assisted reproductive technology (ART) including intracytoplasmic sperm injection (ICSI) has provided new frontiers for the treatment of unreconstructable obstructive azoospermia, including congenital bilateral absence of the vas deferens and failed surgical intervention. Epididymal sperm is obtained by several procedures, including microsurgical epididymal sperm aspiration (MESA), mini-MESA (Modified MESA), macroscopic epididymal sperm aspiration (MaESA) and percutaneous epididymal sperm aspiration (PESA). Since 1991 in our department, epididymal sperm aspiration combined with ART was performed by MESA (26 cases, 41 times) and PESA (3 cases, 4 times). Motile sperm retrieval using MESA and PESA was obtained in 34 out of 36 times (94.4%) and 2 out of 4 times (50%), respectively. MESA-ICSI resulted in a 47.3% 2PN (metaphase II) fertilization rate per eggs and a 28.8% pregnancy rate per transfer. With advancement of ICSI technique in which frozen sperm can be used, elective sperm retrieval can be planned at our convenience. PESA is a convenient, inexpensive and effective outpatient clinic procedure for retrieving sperm assisted with ICSI. In summary, infertile couples need to be given realistic options regarding treatment outcome. The fertility potential and age of the female partner need to be considered when addressing male treatment options.

Epididymis↗

Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia.

PURPOSE: We assessed fertilization, pregnancy and miscarriage rates in patients with obstructive and nonobstructive azoospermia who underwent intracytoplasmic sperm injection. MATERIALS AND METHODS: From June 1996 to March 2000, 166 consecutive patients (198 intracytoplasmic sperm injection cycles) with azoospermia were studied. Of these 198 cycles 68 were performed due to nonobstructive azoospermia using testicular spermatozoa and 130 were performed due to obstructive azoospermia using epididymal spermatozoa. RESULTS: The normal (2 pronuclei) and abnormal (1 plus 3 pronuclei) fertilization rates for obstructive and nonobstructive azoospermia were 60.5% and 16.6%, and 54% and 16.4%, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 30%, 39.8% and 28% for obstructive azoospermia, and 22%, 28.3% and 40% for nonobstructive azoospermia (p <0.05). The normal and abnormal fertilization rates were 58.7% and 21.4% for percutaneous epididymal sperm aspiration (PESA), 62.3% and 10.4% for PESA plus testicular sperm aspiration (TESA), and 57.3% and 14.5% for TESA, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 34.6%, 54.5% and 11.1% for PESA, 37.5%, 37.5% and 33.3% for PESA plus TESA, and 26.1%, 31% and 41% for TESA, respectively (PESA versus PESA plus TESA p >0.05, and PESA and PESA plus TESA versus TESA p <0.05). Epididymal or testicular motile sperm resulted in a lower abortion rate than epididymal or testicular immotile sperm (p = 0.03). CONCLUSIONS: No differences were noted in the fertilization and embryo transfer rates irrespective of etiology (obstructive versus nonobstructive) and type of spermatozoa (epididymal versus testicular). Testicular sperm retrieval results in lower fertilization and pregnancy rates as well as higher abortion rates than epididymal sperm retrieval.

Adult↗

Mouse epididymal Spam1 (pH-20) is released in the luminal fluid with its lipid anchor.

Previously we demonstrated that the murine sperm adhesion molecule 1 (Spam1 or PH-20) is synthesized by the epididymal epithelium, preferentially in the distal region, and is released into the luminal fluid. We also showed that whereas testicular and epididymal Spam1 have hyaluronidase activity at neutral pH, they are under different transcriptional regulation. The aim of this study was to further compare characteristics of the two forms of this glycosyl-phosphatidylinositol-linked protein and their transcripts, and to determine whether secreted epididymal Spam1 is released with its lipid anchor. With GeneRacer amplification of the 3' end of the complementary DNA we show that the poly(A) tails are significantly (P <.05) shorter in the epididymis than in the testis. Two-dimensional polyacrylamide gel electrophoresis with immunoblotting reveals one to three isoforms for epididymal Spam1 with the isoelectric point (pl) ranging from 7.3 to 9.0, and four isoforms ranging from 6.6 to 9.0 pl for testicular Spam1. Two isoforms with a pl ranging from 7.6 to 9.0 were observed for caudal sperm. Lectin blotting analysis shows that Phaseolus vulgaris erythroagglutinin, Lycopersicon esculentum lectin (LEL), and Solanum tuberosum lectin, which all bind to N-linked chains, recognize a 67 kd band in the epididymis and caudal sperm, but not in the testis. Treatment of the protein extracts with anti-Spam1 serum prior to blotting with LEL led to the disappearance of the banding, indicating Spam1 specificity of the staining. The lectin peanut agglutinin, which preferentially binds to O-linked side chains, recognizes a 67 kd band in all three cell types. Enzymatic deglycosylation studies confirmed the presence of an O-linked glycan in all three cell types. Ultracentrifugation of the luminal fluid reveals that epididymal Spam1 is secreted predominantly as insoluble particles, which when treated with phosphatidylinositol-specific phospholipase C or Triton X-100, reveal that the majority of epididymal Spam1 is released with its lipid anchor, a form in which it can bind to sperm.

Animals↗

Effect on clinical outcome of the interval between collection of epididymal and testicular spermatozoa and intracytoplasmic sperm injection in obstructive azoospermia.

We wished to determine whether the interval between surgical retrieval of epididymal and testicular spermatozoa in obstructive azoospermia and their subsequent use in intracytoplasmic sperm injection (ICSI) has an effect on their fertilizing capacity and pregnancy rates in patients undergoing ICSI. This was a retrospective review of 164 consecutive cycles of ICSI in partners of men undergoing surgical sperm retrieval for obstructive azoospermia. Seventy-three cycles used fresh testicular spermatozoa; in 35 cycles ICSI was performed within 4 hours of sperm retrieval, and in 38 cycles spermatozoa were incubated overnight before ICSI. Epididymal spermatozoa were used in 29 cycles; 22 cases within 4 hours of retrieval and 7 cases following overnight culture. Cyropreserved testicular and epididymal spermatozoa were used in 42 and 20 ICSI cycles, respectively. Fertilization and clinical pregnancy rates were calculated for each treatment group. Fertilization rates for epididymal spermatozoa were 67% at 4 hours, 56% at 24 hours, and 63% for cryopreserved spermatozoa (P =.52). Fertilization rates for testicular spermatozoa were 63% at 4 hours, 71% at 24 hours, and 60% for cryopreserved spermatozoa (P =.16). Unlike testicular spermatozoa, cryopreserved epididymal spermatozoa showed a significant increase in clinical pregnancy rates with cryopreservation, with rates of 4 of 22, 1 of 7, and 10 of 20 at 4 hours, 24 hours, and cryopreservation, respectively (P =.049). This study confirms that fertilization and pregnancy rates following ICSI with motile spermatozoa are unaffected by the duration between surgical retrieval of spermatozoa and their injection into oocytes. It also demonstrates that of all treatment modalities, the use of frozen epididymal spermatozoa was associated with the greatest pregnancy rates.

Adult↗

Role of prolactin on epididymal glycoprotein metabolism in matured monkeys, Macaca radiata: specific activities of glycosyltransferases and glycosidases.

Impact of altered serum prolactin status on enzymes involved in glycoprotein metabolism in epididymal tissue of matured monkeys was studied. Hyperprolactinemia (ovine prolactin-250 micrograms/kg body weight/day for 30 days) significantly inhibited the specific activities of dolichylphosphate mannosyl transferase, dolichylphosphate glucosyl transferase and galactosyl transferase, in the epididymal tissues. However, it had an enhanced effect on epididymal glycosidases such as beta-galactosidase, beta-N-acetyl glucosaminidase, beta-N-acetyl galactosaminidase, alpha-mannosidase and alpha-L-fucosidase. Hypoprolactinemia (bromocriptine mesylate-1-mg/kg body weight/day for 30 days) on other hand had no significant effect on the specific activities of both, glycosyltransferases and glycosidases, in the epididymal tissues. The results suggest that hyperprolactinemia inhibits epididymal glycoprotein metabolism by impairing the incorporation of oligosaccharide units into proteins with enhanced degradation. This may have adverse effect on events leading to sperm maturation in epididymal environment.

Animals↗

Feasibility of microsurgical reconstruction of the male reproductive tract after percutaneous epididymal sperm aspiration (PESA).

For obstructive azoospermia, surgical sperm retrieval from the epididymis for IVF/ICSI is an established management. However, various recent studies have established that surgical reconstruction with vasovasostomy or vasoepididymostomy remains a more cost-effective treatment option than upfront assisted reproduction. After epididymal sperm retrieval, fibrosis and scarring of the punctured epididymal tubule can lead to complete epididymal obstruction. The feasibility of surgical reconstruction after surgical epididymal sperm retrieval has not been established. We describe two cases of bilateral microsurgical vasoepididymostomy, using a new 2-suture longitudinal intussusception technique we previously described, after previous successful bilateral percutaneous epididymal sperm aspiration (PESA). In both cases, motile sperm were found in ejaculate in the first post-operative semen analysis at 6 weeks and 2 months. We conclude that even in men with previous epididymal sperm retrieval, surgical reconstruction remains a feasible management option for fertility.

Adult↗

In vitro fertilizing ability of testicular, epididymal, and ejaculated rabbit spermatozoa.

The fertilizing ability of testicular, epididymal, and ejaculated rabbit spermatozoa was evaluated in vitro following in vitro capacitation by high ionic strength treatment. Fewer than 11% of inseminated ova were apparently fertilized (i.e., in pronuclear, two-, and four-cell stages as determined by light microscopy) when testicular sperm treated with caffeine, caput epididymal, or corpus epididymal sperm samples were tested. A greater fertilizing ability, reflected by the percentage of ova fertilized and more normal progression of embryonic development, was exhibited by cauda epididymal sperm. Of 93 ova, 68 (73.1%) were fertilized by cauda sperm, whereas ejaculated sperm from the same 10 bucks fertilized 34 (36.6%) of 93 ova (P is less than 0.005). Ultrastructural examination of selected ova apparently fertilized by sperm from levels of the male reproductive tract proximal to the cauda epididymidis revealed abnormal activation. Authentic fertilization occurred when ova were inseminated with cauda epididymal and ejaculated sperm. An unusual and infrequent form of activation involving failure of cortical granule breakdown in ova penetrated by cauda epididymal and ejaculated sperm was seen. A comparison of fertilizing ability of sperm from first, second, and third ejaculates revealed a significant decrease with the third ejaculate (P is less than 0.01).

Animals↗

Effect of alpha-blockers on epididymal sperm concentration, motility and testicular productivity in the rat.

The present study was undertaken to determine whether alpha-blockers affect epididymal sperm parameters and testicular spermatogenesis. Sprague-Dawley rats were given orally a 1 mg/kg body weight dose of Bunazosin, a selective alpha-adrenoreceptor antagonist, daily for one month as a short-term administration group and three months as a long-term administration group. Using a micropuncture technique, epididymal sperm concentration and sperm motility were measured. Epididymal sperm concentrations were significantly increased in the Bunazosin group, but progressive motility of spermatozoa were not altered. Daily testicular sperm production was also increased after administration of Bunazosin. There were no differences in epididymal sperm concentration and daily sperm production between the one-month group and three-month group. An epididymal wide storage capacity and short transit time after administration of the alpha-blocker could increase the sperm concentration in the cauda epididymidis. Because there were no differences in the epididymal sperm parameters and daily testicular sperm production between the two groups, these changes may occur at 1 month after administration of the alpha-blocker. Moreover, the alpha-blocker might affect testicular function.

Adrenergic alpha-Antagonists↗

Discriminant analysis indicates a single sperm protein (SP22) is predictive of fertility following exposure to epididymal toxicants.

In a previous study, we found that ethane dimethanesulphonate (EDS) compromised the fertilizing ability of proximal cauda epididymal sperm from the rat within 4 days of exposure, an effect that persisted in castrated, testosterone (T)-implanted animals, establishing direct action on the epididymis. This EDS-induced reduction in fertilizing ability was highly correlated with a quantitative decrease in specific sperm protein. Here we sought to determine whether the fertility of proximal cauda epididymal sperm recovered from animals exposed to a variety of male reproductive toxicants could be predicted by assessing quantitative changes in specific sperm protein(s), or whether more common endpoints (e.g., sperm motility, sperm morphology, serum and epididymal tissue T, cauda epididymal sperm reserves) also are required to predict fertility. Intact adult male rats were dosed with EDS (25 or 50 mg/kg), chloroethylmethanesulphonate (CEMS; 12.5 or 18.75 mg/kg), or epichlorohydrin (EPI; 3 or 6 mg/kg) daily for 4 days. Castrated, T-implanted rats were dosed with hydroxyflutamide (HFLUT; 12.5 or 25 mg/kg) daily for 5 days. On day 5, proximal cauda epididymal sperm were inseminated in utero into receptive, cervically stimulated adult females, and on day 9, fertility (implants/corpora lutea) was assessed. Fertility-was decreased by the higher dose of each toxicant (P < 0.05) and also by the lower dose of EPI and HFLUT. Likewise, an acidic 22 kDa sperm protein (SP22) was decreased quantitatively (P < 0.05) in silver-stained two-dimensional gels by the higher dose of each toxicant as well as by the lower dose of EPI and HFLUT. Although sperm motility and serum T were altered by specific exposures, these endpoints were not useful in predicting fertility. In contrast, SP22 was highly correlated (P < 0.0001; r2 = 0.83) with fertility. Indeed, the amount of SP22 correctly predicted 90% and 94% of the fertile (> 50% fertility) and subfertile (< 50 fertility) animals, respectively, when discriminant analysis was performed. Thus, the amount of SP22 in a cauda epididymal sperm sample may be a useful predictor of fertility in toxicant-treated animals.

Animals↗

TCPL delivery system: the role of DHT, DHEA, and E on the epididymal tubules of adult male rats.

Recent studies reported from our laboratory have established that the sustained delivery of danazol in combination with androgens resulted in the remarkable reduction of epididymal mass. In addition, previous studies have recommended that ultrastructural of epididymal tubules have to be elucidated. The specific objective of this investigation was to evaluate the cytological characteristics of epididymal tissues exposed to sustained delivery of dihydrotestosterone (DHT), dehydroepiandrsterone (DHEA) and a combination of Estrogen (E), DHEA plus DHT by means of tricalcium phosphate lysine (TCPL) delivery system. Adult male rats (BW 300-350 gm) were randomly divided into four equal groups: Group I animals were implanted i.p. with TCPL loaded with DHEA (100 mg). Animals in group II were implanted with TCPL capsules loaded with DHEA (100 mg) + DHT (500 mg). Group III animals were implanted with TCPL capsules loaded with E (200 mg) + DHEA (100 mg) + DHT (500 mg). Group IV animals served as the intact unimplanted controls. Surgical aseptic techniques were performed according to standard laboratory procedures. The animals were maintained at the University of Mississippi Medical Center Animal Facilities following the rules and regulations established by NIH on the Care and Use of Laboratory animals. At the end of 6 weeks post implantation, all animals were sacrificed and the epididymal tissues were collected, weighed, and embedded for histopathological evaluations. Statistical analysis was conducted by using standard computer programs (STATVIEW, ANOVA at 95% CI). The data obtained in this investigation demonstrated the following: (1) remarkable reduction in sperm counts and motility obtained from epididymal tubules in all experimental (hormonally treated) groups, (2) the lumen of the epididymal tubules were devoid of sperm in animals treated with DHT in comparison to the control, (3) a decrease in the diameter of tubules with occasional hypertrophic epithelium in all experimental animals, (4) disorganization of nuclear material was observed in animals treated with DHEA and DHEA + E + DHT in comparison to the control group. The overall observation of this study suggests that sustained delivery of DHEA, DHEA + DHT, and DHEA + DHT + E can be used to regulate the structural and functional architecture of the site of extramaturation of spermatozoa.

Animals↗

A patient with seminal vesiculitis prior to acute chlamydial epididymitis.

This is the first report of a case of seminal vesiculitis prior to acute chlamydial epididymitis. At the first visit to the clinic, the patient wished to check whether he had Chlamydia trachomatis in his genital tract, because his wife had been diagnosed as having chlamydial cervicitis. He had no specific symptoms at that time; however, transrectal ultrasonograpy (TRUS) revealed swelling of seminal vesicles, which suggested the presence of seminal vesiculitis. Two days after the first visit, he had high-grade fever and was diagnosed as having acute epididymitis caused by C. trachomatis. We had previously reported that seminal vesiculitis was always complicated with acute epididymitis, so this case could provide important evidence that seminal vesiculitis might precede acute epididymitis. It suggested that acute epididymitis could be affected by seminal vesiculitis via the retrograde transmission route.

Acute Disease↗

Epididymitis in children: the circumcision factor?

PURPOSE: Recommendations for circumcision have significantly altered in the last several years. Studies have objectively established an increased risk of urinary tract infection in uncircumcised boys. We evaluated the relationship between epididymitis and circumcision status. MATERIALS AND METHODS: We studied the relationships among the circumcision status of 36 consecutive boys with epididymitis in a review of 128 with acute scrotal inflammation (group 1), circumcision status of 43 in whom the diagnosis of epididymitis at discharge home had been made elsewhere (group 2), New York State hospital discharge figures for circumcision in newborns (group 3) and the regional prevalence of circumcision in 200 consecutive pediatric emergency department patients at the same institution with nonurological diagnoses (group 4). RESULTS: New York State Department figures indicate that 70% of male newborns are discharged home with a hospital code for circumcision. Similarly an evaluation of 200 consecutive male patients without urological diagnoses younger than 18 years in the emergency department revealed that 131 (65%) were circumcised. Comparatively in groups 1 and 2 only 25 and 26% of patients, respectively, were circumcised. The statistical difference in circumcision status among the 4 groups was significant (p >0.0004). CONCLUSIONS: These data demonstrate with highly statistical significance that a relationship exists between epididymitis and the presence of a foreskin. We found that an intact foreskin is an important etiological factor in boys with epididymitis.

Acute Disease↗

Antimicrobial tissue penetration in a rat model of E. coli epididymitis.

Following induction of unilateral epididymitis by intratesticular injection of E. coli, a single intraperitoneal dose of amdinocillin, ampicillin, doxycycline, tobramycin, or trimethoprim/sulfamethoxazole was administered to five groups of rats. The animal was sacrificed serially and concentrations of antibiotic in serum, infected epididymides, and non-infected epididymides were determined by high performance liquid chromatography. The ratio of infected to non-infected tissue area under the curve values was 1.05 for trimethoprim, 1.58 for sulfamethoxazole, 1.67 for amdinocillin, 2.01 for tobramycin, 2.25 for doxycycline, and 2.58 for ampicillin. Except for trimethoprim, infected tissue concentrations were significantly greater than compared to uninfected epididymal levels (p less than 0.05). Antibiotic concentrations in infected epididymides compared to serum revealed overall penetration of 34% for amdinocillin, 66% for sulfamethoxazole, 70% for ampicillin, 76% for tobramycin, 256% for trimethoprim, and 257% for doxycycline. In a rat model of epididymitis, trimethoprim and doxycycline demonstrated the greatest degree of epididymal penetration compared to serum. All antibiotics except trimethoprim had significantly greater penetration into infected tissue when compared to non-infected epididymal tissue.

Animals↗