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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.
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The movement of radio-opaque medium in the vas deferens of rabbits during sexual rest, after sexual stimulation, and after ejaculation, was followed. Bilateral injections of 20 microliter Ethiodol were given at the vas-epididymal junction in the urethral direction. Serial radiographs revealed proximal transport of the dye (towards the testis) within 24 h and total containment in the cauda epididymidis within 1-4 days. Subsequently, small amounts of dye moved from the epididymis through the vas and out of the urethra during sexual rest until no dye remained (11 days-8 weeks). Animals with a ligated vas deferens showed no decrease in dye density. Sexual stimulation moved the dye from the epididymis into the vas. The dye was then either rapidly transported proximally during subsequent rest or removed distally if ejaculation followed stimulation. Ejaculation removed some vasal and epididymal dye via the urethra; however, dye left in the vas after ejaculation was rapidly (< 30 min) transported to the proximal duct and then into the epididymis by 24 h. It is concluded that vasal contents are transported in both urethral and testicular directions during sexual rest and that, after stimulation and ejaculation, the rate of proximal transport is increased. This may be indicative of a sperm removal mechanism by the vas deferens which involves the maintenance of an optimal sperm number in the cauda epididymidis at all times.
This study was conducted to evaluate postpubertal testicular and epididymal epithelial changes induced by unilateral epididymal and vasal obstruction in rats by measuring epithelium thickness of seminiferous tubuli (MSTet) and epithelium thickness of ductus epididymis (MDEet). Rats were randomly divided into 3 groups: group I underwent unilateral epididymal ligation; group II underwent unilateral vasal ligation and group III received sham operations. MDEet on the ipsilateral side of the epididymal ligation group significantly decreased compared to the contralateral side and sham group. For the contralateral side of the ligated vas, MDEet significantly decreased compared to the ipsilateral side and sham group. MSTet was less on the side of the operation than the contra lateral side and the sham group after both surgical procedures. The obstruction point of the male genital tract affect sperm parameters for clinical extraction or aspiration procedures.
PURPOSE: We present a minimally invasive endoscopic approach for the treatment of persisting mesonephric duct in male infants. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Micropuncture techniques adapted for in vivo use in the male reproductive tract were used to study the effect of vasectomy on the concentration and morphology of spermatozoa in the seminiferous tubules and ductus epididymidis of the rat. Regardless of surgical technique, 85% of all rats which had previously under vasectomy developed a speratic granuloma at the proximal end of the ligated vas deferens. Vasectomy did not affect the weights of the ipsilateral (vasectomized) testes. Vasectomy without granuloma formation resulted in an elevation in the weight of the ipsilateral epididymis and an increase in the concentration of spermatozoa in the ipsilateral cauda. Vasectomy complicated by granuloma formation caused a significant increase in the ratio of the spermatocrit in the seminiferous tubule to that in the caput. In the vasectomized rat without granuloma, significantly more abnormal spermatozoa were in the caput than in the cauda; in the normal rat, the concentrations of abnormal spermatozoa in the two regions were not significantly different. Vasectomies with and without granuloma formation are distinct phenomena and should be investigated separately.
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.
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.
The expectation that male sterilization would not be an acceptable method of fertility control to the Latin American male has not been upheld in the initial phases of male sterilization programs in Colombia, Costa Rica, Guatemala, and El Salvador. On the contrary, in all of these programs and also at the Asociación Demográfica Salvadoreña, a free-standing, non-profit family planning clinic in San Salvador, the initial success has been impressive, with 180 men accepting sterilization during the first two years (February, 1972 to February, 1974). All sterilizations were performed by excising a 10-15 mm segment of each vas and ligating each vas end. Procedures were performed on an outpatient basis using a local anesthetic. Follow-up examinations were conducted at one week and three months after the procedure. Although complications were reported by 24.0% of the subjects at the one-week follow-up, the complications were minor: most were scrotal infections not requiring antibiotic therapy. Rates of complications were low for subjects returning for a three-month examination and semen test. Only one subject had a positive semen test.
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210 million contraceptive operations, which include vasoligation, tubal ligation, and implanting of IUDs, were carried out in China in the 9 years from 1971-1979, according to sources from a national working conference on birth control techniques which closed here yesterday. The conference was called to help implement China's birth control policy with stress on the rural areas. The goal is to limit the country's population to 1200 million by the turn of the century. The Ministry of Public Health has issued regulations on dispensing of the various methods of contraception, the conference said. Health workers are instructed to popularize all methods and increase their proficiency. At the conference, proposals were raised on how to spread knowledge of birth control, promote research, production and supply of contraceptive drugs and devices and introduce safe and simple methods and highly-efficient contraceptive pills. At present, a network of technical guidance teams, stations, research institutions, and operation service groups have been set up in all provinces, municipalities and autonomous regions across the country. Great efforts are being made to train technically proficient medical workers in all counties, the conference said.
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Vasectomy has become a popular method of family planning in recent years in Australia. The relatively simple procedure is effective, has few complications and usually does not require hospitalisation.
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