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Considerations in selecting a postvasectomy semen examination regimen.

The criteria for declaring a vasectomized man sterile have been the subject of debate for many years, yet most suggested regimens differ. The problem lies in the remaining unanswered physiologic questions of such a fundamental nature as to frustrate attempts to formulate a regimen based strictly on medical considerations. The rates of disappearance of sperm following vasectomy vary considerably among men. The physiologic basis for these variations are herein discussed for the first time. At present, regimens reflect, for the most part, social considerations, according to the values and perceptions of the individual physician. The problems raised by postvasectomy residual sperm and current formulation of regimens are described.

Ejaculation↗

Vasectomy with rivanol injection and fertility control by vital staining with eosin.

A material is presented of 66 males who were treated with Rivanol injection during vasectomy in order to obtain immediate sterility. The fertility control was established using vital eosin staining on seminal fluid at home. One case of recanalization occurred. All patients had infertile spermatozoa or aspermia 10 days after surgery. Increased frequency of complications was not observed. Vital staining with eosin is found to be practical and easily used.

Acridines↗

Soluble CD46 (membrane cofactor protein, MCP) in human reproductive tract fluids.

CD46 (membrane cofactor protein, MCP) is a cell surface complement regulatory protein which may have an additional role in human sperm-egg interaction. A soluble form (sCD46) has also been detected in a number of biological fluids, most notably seminal plasma. The present study has employed a monoclonal antibody-based ELISA to assay sCD46 in reproductive tract fluids in normal and pathological conditions. Large amounts of sCD46 were detected in seminal plasma of both fertile and infertile men (combined mean, 4859 ng/ml). Vasectomized men had lower levels (mean, 2421 ng/ml), indicating contributory sources both before and after the vas deferens ligation site. Pre-colostrum also contained relatively high quantities (mean, 445 ng/ml), whereas breast milk (mean, 117 ng/ml), peritoneal fluid (mean, 154 ng/ml) and follicular fluid (mean, 107 ng/ml), as well as uterine (mean, 208 ng/ml), umbilical (mean, 166 ng/ml) and peripheral (mean, 206 ng/ml) blood plasma, had sCD46 levels within a comparable range. Amniotic fluid had low sCD46 concentrations (mean, 22 ng/ml). In endometriosis, peritoneal fluid levels of sCD46 were significantly raised (mean, 199 mg/ml). These results indicate distinctive fluid compartmentalisation of sCD46 consistent with a biological function in human reproductive tract fluids.

Amniotic Fluid↗

Orchidopexy or orchidectomy for preventing tissue hypoxia in contralateral testis following induction of ipsilateral abdominal testis associated with vas deferens obstruction.

INTRODUCTION: An experimental study was planned to evaluate and compare the effects of orchidopexy and orchidectomy on ipsilateral and contralateral testes in rats subjected to ipsilateral abdominal testis and vas deferens obstruction. MATERIALS AND METHODS: Four groups of 12 rats each were established. Sham operation, intra-abdominal testis with vas deferens obstruction and orchidopexy or orchidectomy for prior intra-abdominal testis with vas deferens obstruction were performed in groups 1, 2, 3 and 4, respectively. While testes were maintained for 8 weeks in the same position in groups 1 and 2, orchidopexy or orchidectomy was performed in groups 3 and 4 after the first 4 weeks, and the remaining testes were harvested after an additional 4 weeks. Lactic acid hypoxanthine contents were determined and the groups were compared with the paired t test. RESULTS: Maintaining intra-abdominal testis with vas deferens obstruction for 8 weeks and orchidopexy yielded the highest lactate values. However lactate levels in contralateral testes did not increase. On the other hand, hypoxanthine levels revealed the highest values after the initial 4 weeks. The 8-week study period resulted in increases of ipsilateral and contralateral testicular hypoxanthine levels. Orchidopexy caused a decrease in ipsilateral testicular values and ameliorated the increase in hypoxanthine levels in contralateral testes. CONCLUSIONS: Replacing an intra-abdominal testis with its vas deferens ligated into the scrotum ameliorates the oxidative stress in both ipsilateral and contralateral testes. Since orchidectomy does not result in better contralateral testicular values, orchidopexy should be preferred when treating an undescended testis with vasal obstruction.

Animals↗

[Determination of auto-antibodies against spermatozoa after vasectomy and epididymectomy by indirect immunofluorescence (author's transl)].

As a result of successful recanalization of the vas deferens, a low pregnancy rate has been observed. The formation of auto-antibodies is considered as cause. In vasectomized and epididymectomized rats, the presence of auto-antibodies against spermatozoa was proven by indirect immunofluorescence. After uni- and/or bilateral obstruction of the vasa, the formation of antibodies against spermatozoa takes place which - after 2 months - proves to be permanent for 9 months, then showing a decreased titre. An animal model is presented suitable for the study of immunological processes in unilateral gonadal diseases.

Animals↗

Vasectomy for voluntary male sterilisation.

Vasectomy was performed in 90 men in Department of Surgery II of the University Central Hospital of Helsinki during the period January 1st, 1972 to December 31st, 1973. Operation was performed on an ambulatory basis under local anesthesia. After resection and ligation of vas deferens the cut ends were placed in different fascial planes in order to avoid recanalisation. The patients were mainly in the age group 31-40 years. Seven patients had postoperative complications, scrotal hematoma being the most common. Recanalisation was found in one patient, in whom a new operation was performed. The author stresses the importance of a correct vasectomy method, histological verification of the divided vasa and most of all the postoperative sperm analysis. Two negative sperm analyses with an interval of at least 1 month must be recorded before sterility can be confirmed.

Adult↗

A second look at Steinach's second procedure: testiculoepididymal occlusion in man and dog.

After advocating vas occlusion as a biological method for rejuvenating aging males, Steinach had suggested that the effect might be more pronounced if the obstruction were placed proximal to the epididymis. This Steinach II procedure has now been studied in 15 dogs and five men. Occlusion was performed at the level of the vasa efferentia, avoiding any vascular trauma. Radiological visualization confirmed a perfect block. There were no untoward reactions, such as orchitis or hydrocele. In dogs, widespread degeneration in the seminiferous tubules was evident, and the total Leydig cell volume showed an increase from 0.7 to 1.0 ml/testis. The changes, however, were not significantly different from conventional vasectomy. In men, there were considerable preexisting senile changes, and the total Leydig cell volume was already as high as 2.8 ml/testis. These changes obscured any possible effect of Steinach II operation.

Animals↗

The bipolar needle for vasectomy. I. Experience with the first 1000 cases.

A battery-powered, bipolar electrocoagulator has been specifically developed for sealing the cut ends of the divided vas at vasectomy. With a minimum of electric power, the electrocoagulator destroys only the mucosa and one or two muscle cell layers of the vas, which leads to optimal fibrosis of the cut ends. This instrument has been used in more than 1000 vasectomies without a known failure and with a minimum of complications. An analysis of these cases is reported with emphasis upon the method's success in sealing the vas.

Adult↗