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PubMed2005

Epididymal sparing bilateral simple orchiectomy with epididymoplasty: preservation of esthetics and body image.

PURPOSE: We report the surgical technique and results of epididymal sparing bilateral simple orchiectomy as an esthetic alternative to standard bilateral simple orchiectomy and luteinizing hormone releasing hormone (LH-RH) agonist injection therapy in patients with prostate cancer. MATERIALS AND METHODS: The study included 91 consecutive epididymal sparing bilateral simple orchiectomy (BSO) procedures that were performed at the Atlanta Veterans Affairs Medical Center during a 25-month period. All patients had pathologically confirmed prostate cancer. A total of 52 patients (57.1%) were receiving LH-RH agonist therapy prior to the procedure and the remaining 39 (42.9%) were not. All procedures were performed in an outpatient clinic setting using spermatic cord anesthesia block as the only method of anesthesia. In the 52 patients who were on LH-RH agonist therapy prior to the procedure the overall impression/satisfaction with the procedure was evaluated using a questionnaire. RESULTS: All 91 procedures were performed at the urology outpatient clinic using local anesthesia. Mean patient age was 74.2 years (range 44 to 86). Mean serum prostate specific antigen was 58.9 ng/ml. The mean time required to perform the spermatic cord anesthesia block was 3.9 minutes (range 2 to 6) and the volume of anesthetic solution was 18.9 ml per case (range 10 to 32). Despite significant difference in testicular size between patients receiving and not receiving LH/RH agonists there were no differences in anesthesia time or anesthetic volume (3.9 and 3.9 minutes, p = 0.97, and 18.6 and 19.4 ml, respectively, p = 0.47). Mean operative time for BSO excluding anesthesia time was 36.9 minutes (range 18 to 70). Mean operative time was similar in patients receiving and not receiving LH-RH agonists (36.2 and 37.8 minutes, respectively, p = 0.39). The procedure was well tolerated, as judged by the mean intraoperative pain score during BSO of 0.2 (range 0 to 3). The majority of patients (76 or 83.5%) were pain-free during the procedure. Pain scores were similar in patients who were and were not receiving LH-RH agonists during BSO (p = 0.97). There were no adverse events. Followup data were available on 26 of the 52 patients who were receiving LH-RH agonist therapy prior to the procedure. Of them 96.2% were satisfied with the results and 84.6% preferred the procedure over medical castration therapy with LH-RH agonist therapy. CONCLUSIONS: Epididymal sparing bilateral simple orchiectomy is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anesthesia. Preservation of the epididymis and subsequent epididymoplasty is effective for maintaining the esthetic appearance of the scrotum and patient satisfaction. The procedure offers patients the convenience of 1-time surgical therapy over lifelong medical injection therapy at a significantly lower cost and without significantly compromising the esthetic appearance of the scrotum.

Adult↗

PubMed1985

Effect of intra-epididymal injection of copper particles on fertility, spermatogenesis, and tissue copper levels in rats.

In male rats, a single injection of 10 mg metallic copper particles in oil into each caput epididymidis induced infertility, whilst leaving mating behaviour and blood testosterone levels unchanged. Fertility tended to recover 5.5 months after the copper treatment. Although the copper content of the caput epididymidis reached a level of around 100 times higher than control values, the serum copper concentration did not rise significantly. This finding and the observation that treated animals gained weight as fast as the controls suggest a low systemic toxicity of this method. The testicular copper concentration was significantly higher than that in controls and different degrees of damage, including vacuolation, karyorrhexis, pyknosis, and cytolysis, were seen mainly in pachytene spermatocytes and early spermatids. Clumps of foreign particles, apparently metallic copper, were found in the interstices of the caput epididymidis together with degenerative changes in the epithelial cells of the caput, suggesting a possible effect of copper on the epididymal epithelium. The viability of epididymal sperm decreased more markedly than the decrease in sperm density. It is therefore most likely that the major cause of infertility after copper injection into the caput epididymidis is a direct inhibitory effect of copper on the sperm, whilst damage to the seminiferous and epididymal epithelial may contribute.

Animals↗

PubMed1987

Patterns of human epididymal fluid proteins on polyacrylamide gel electrophoresis.

Proteins were analysed by sodium dodecylsulphate polyacrylamide gel electrophoresis in fluid taken from six epididymal regions in 10 men undergoing microsurgery to bypass epididymal obstructions resulting from various disorders. Some major proteins common to most samples were identified with apparent molecular weights of 95, 67, 56, and 44 kilodaltons. A degree of regional specificity in the synthesis and secretion of epididymal proteins was indicated. There appeared to be no correlation between protein pattern or the abundance of individual proteins and the cause of obstruction, although methodological constraints may have partially obscured any such relationship.

Body Fluids↗

PubMed1989

Influence of epididymal maturation on cyclic AMP levels in hamster spermatozoa.

Whilst in their native epididymal fluid, sperm from the caput epididymis of the rat and hamster contain significantly (P less than 0.01) greater amounts of cAMP than do sperm from the cauda epididymis. The cAMP levels in both cell types from these species underwent a rapid increase concomitant with dilution to a density of 20 x 10(6)/ml. Further analyses in the hamster indicated that this increase was calcium-dependent, and could be enhanced by treatment with the calmodulin antagonist, calmidazolium. Dilution of hamster sperm to a concentration of 1 x 10(6)/ml was not associated with a rapid rise in cAMP levels. This effect was shown to be due to the dilution of a component in epididymal plasma. When incubated at this lower density, the cAMP content of hamster caput sperm remained low over a 3 h period, whilst similarly treated caudal sperm exhibited a progressive rise in cAMP levels. Thus, in contrast to other species, cAMP does not appear to play a pivotal role in acquisition of the capacity for movement during epididymal maturation in the rat and hamster. However, this nucleotide may be involved in the post-ejaculatory modifications of motility which accompany the terminal stages of capacitation.

Animals↗

PubMed1994

Assessment of protein synthesis and secretion by rat seminiferous and epididymal tubules in vivo.

In vivo microperifusion and micropuncture were used to study tubule protein synthesis and proluminal secretion by the male reproductive tract in vivo. Seminiferous and caput and cauda epididymal tubules were perifused for 3 h. with [35S]-methionine. Perifused interstitial fluid (IF), lumen fluid (LF), and tubule extract (TE) were collected. Proteins were separated by SDS-PAGE, and autoradiograms were developed. Trichloroacetic acid precipitable proteins in each fluid were determined and a protein synthesis index (PSI) was calculated. PSI values demonstrated that the cauda epididymis synthesized less protein in vivo than did either seminiferous or caput tubules. Seminiferous tubules synthesized and secreted into the tubule lumen a relatively constant panel of proteins. Epididymal tubules synthesized and secreted proteins in a region-specific manner. In the caput epididymis the most prominent secreted bands were consistent with the heavy and light chains of epididymal clusterin. In the cauda epididymis, the most prominent synthesized and secreted protein was a 25 kDa protein consistent with the protein D. The above approach to studying protein synthesis and secretion will allow direct study of the physiological and pathophysiological effects on this important epithelial function in vivo.

Animals↗

PubMed1995

Bulk sperm collection by epididymal micropuncture and stimulation of the spermatic nerve; a novel method for sperm retrieval for IVF for surgically irreparable vasal obstruction.

We have developed a new sperm collection method by epididymal micropuncture in conjunction with perivascular nerve stimulation to obtain as many uncontaminated spermatozoa as possible for IVF for patients with surgically unreconstructable vasal obstruction. Fifteen azoospermic men with congenital absence of the vas deferens or vasal obstruction not amenable to surgical repair enrolled in this study. Under general anaesthesia the testis and epididymis were retrieved and stabilized in a testicular holder with the aid of 2% agar. The epididymal micropuncture was performed using a micropipette placed in a micromanipulator. A pair of Ag-AgCl ring electrodes were placed around the spermatic cord for perivascular nerve stimulation with DC (intensity 136 V, frequency 20 Hz) for 30 s. Electrical stimulation was repeated every 1 min until no further fluid was obtained. Epididymal fluid obtained ranged from 78 to 980 microliters (mean 169 microliters). Sperm concentration ranged from 0.7 to 200 million (mean 53.5 million). Sperm motility ranged from 0.5% to 70% (mean: 19.9%). The percentage of spermatozoa with normal morphology ranged from 3% to 32% (mean 16.4%). Of 16 cycles in which spermatozoa and oocytes were retrieved, 56% (9/16) resulted in fertilization and 18.8% (3/16) developed clinical pregnancies. The clinical pregnancy rate per couple was 20% (3/15). This is the first clinical experience of the bulk sperm collection system for IVF for the treatment of unreconstructable obstructive azoospermia. Our results indicate that our new technique, in conjunction with IVF, is clinically useful for patients with surgically irreparable vasal obstruction.

Cell Separation↗

PubMed1995

In vitro fertilization and the effect of progesterone and 17 alpha-hydroxyprogesterone on acrosome reaction of mouse epididymal spermatozoa.

This study assessed the effect of progesterone and 17 alpha-hydroxyprogesterone (17 alpha-OH-progesterone) at concentrations of 0.01-10 micrograms/ml, on the acrosome reaction and in vitro fertilizing ability of mouse epididymal spermatozoa. Cumulus masses containing oocytes were cultured in Brinster's medium, to which were added capacitated epididymal spermatozoa which had been incubated in medium with various concentrations of progesterone or 17 alpha-OH-progesterone for 90 min. IVF success rate was assessed 20-24 h following insemination. Progesterone was found to increase the fertilization rate at the 1 microgram/ml and 10 microgram/ml concentrations while lower concentrations had no effect. However, 17 alpha-OH-progesterone failed to show any effect on fertilizing ability. Incubation of epididymal spermatozoa in medium containing 1 microgram/ml and 10 micrograms/ml progesterone significantly increased the acrosome reaction as monitored by a chlortetracycline fluorescence assay. 17 alpha-OH-progesterone, however, failed to show any effect on the acrosome reaction. The results suggest direct effects of progesterone, but not of 17 alpha-OH-progesterone, on fertilization and the acrosome reaction of mouse spermatozoa.

17-alpha-Hydroxyprogesterone↗

PubMed1995

Effects of ischaemia on the caput epididymis and its relationship to higher epididymal obstruction: a qualitative study in the ram.

The objective of this study was to determine if localized ischaemia of the caput epididymis in the ram causes morphological changes similar to those characteristic of higher epididymal obstruction in humans. This was tested by performing unilateral occlusion of the superior epididymal artery in 10 rams. At the end of 4 (n = 5) or 28 weeks (n = 4), rams were castrated and the testes and epididymides were weighed. Analysis of histological sections at the light microscope level provided quantitative data on lumen diameter and epithelial cell height of the efferent ducts. Qualitative analysis and specific histochemical stains for identification of lipofuscin pigment provided further information on tissue changes. Electron microscopy was performed on the efferent ducts to assess ultrastructural changes. The results revealed that localized ischaemia of the proximal epididymis caused a dramatic change in tubule calibre of the efferent ducts and initial segment resulting in obstruction of the distal lumina. These changes were more severe following 28 weeks of arterial occlusion. The epithelial cells of the proximal region showed an increase in the number of lysosomes and they became active in phagocytosis of spermatozoa. Lipofuscin pigment accumulated within the epithelial cells and also in macrophage-like cells that had invaded the lumina, interstitium and intra-epithelial regions of the ducts. On the basis of these observations we conclude that the tissue changes which occur in the ram epididymis as a result of localized ischaemia show a striking similarity to those seen in men exhibiting higher epididymal obstruction. This suggests the possible implication of vascular disorders in the aetiology of obstructive azoospermia in men.

Animals↗

PubMed1996

Epididymal oxytocin in the rat: its origin and regulation.

Oxytocin is localized to the Leydig cells of the testis in the rat and several other species where it is postulated to play a role in steroidogenesis and seminiferous tubule contractility. Oxytocin has also been detected in the epididymis of the ram where active uptake of the peptide from luminal fluid has been demonstrated. This study was performed to investigate whether oxytocin is present in the rat epididymis, and the origin of the peptide. Immunoactive oxytocin was detected in the epididymis of all control animals examined (147.7 +/- 41.7 pg/g). Total epididymal oxytocin was reduced significantly following castration (p < 0.05). Testosterone treatment also reduced the epididymal concentration of the peptide in both intact and castrated rats. Efferent duct ligation (EDL) did not affect the presence of oxytocin in the epididymis. Immunoactive oxytocin was localized in discrete cells of the epithelium of the caput epididymis, with less staining apparent in the initial segment and cauda epididymis. Staining disappeared from the caput epididymis following castration, but reappeared following testosterone supplementation. No obvious alteration in staining was observed in the cauda epididymis after EDL. These data demonstrate for the first time the presence of oxytocin in the epididymis of the rat and that the peptide may be regulated by androgens. They further suggest an epididymal source of the peptide.

Animals↗

PubMed2006

Epididymal obstruction results in isolated sperm heads in post-vasectomy rats.

The aim of this study was to determine if, following vasectomy, epididymal obstruction resulted in changes in vasal stump fluid using a rat vasectomy model. One hundred and twenty-two mature male rats underwent bilateral surgical vasectomy and subsequent unilateral epididymal obstruction. Animals were randomly assigned to one of the five cohorts, which determined the time to kill and vasal fluid assessment. Numbers of whole sperm and sperm heads were compared between the obstructed and non-obstructed sides. Parametric analysis of microscopic vasal fluid findings was performed using a paired t-test. Whole sperm and sperm heads were detected bilaterally among the initial five cohorts. On the obstructed epididymis side, percentage of whole sperm dropped from 36.9% to less than 1% and sperm heads increased from 63.2 to 99.7% at 12 weeks post-obstruction (p < 0.05 at each time interval). On the unobstructed side, percentage of whole sperm rose from 66.3 to 89.5% and sperm heads dropped from 33.7 to 10.5% (p < 0.05 at each time interval). At 12 weeks, the difference between the obstructed and non-obstructed sides for both percentage and quantity of whole sperm and heads was significant with a p value of <0.001. In this rat model, following vasectomy and subsequent epididymal obstruction, testicular vasal stump fluid will contain progressively diminishing numbers of whole sperm and increases in the percentage and absolute numbers of sperm heads.

Animals↗

PubMed1976

Alkaline phosphatase activity of epididymal contents in boars with normal or reduced spermatogenesis.

The alkaline phosphatase activity was measured in testicular fluid and in epididymal plasma from caput and cauda epididymidis in boars with normal sperm production and in boars in which the number of spermatozoa passing from the testis to the epididymidis was reduced. The testicular fluid and the epididymal plasma from caput epididymidis contained low amounts of alkaline phosphatase in comparison with epididymal plasma from the cauda. This applies to both groups of boars e.g. boars with normal as well as with totally lacking or lowered sperm production. As no fluid resorption takes place between caput and cauda the distal part of the epididymidis must be the main production site for alkaline phosphatase. The production there is not related to the presence of spermatozoa in the duct. In the caput, on the other hand, it seems that the level of alkaline phosphatase in some way is influenced by the sperm supply to the duct.

Alkaline Phosphatase↗

PubMedDate not supplied

Effect of various prostaglandins on the metabolism of fructose by epididymal and ejaculated ram spermatozoa in vitro.

The effects of a number of prostaglandins on the metabolism of fructose by epididymal and ejaculated ram spermatozoa were investigated using conventional Warburg techniques. Spermatozoa from the two sources were collected concurrently during electrical stimulation; the epididymal spermatozoa were harvested via a cannula inserted chronically into one vas deferens and thus were free from exposure to the seminal prostaglandins. In general, the metabolism of fructose by the spermatozoa was little affected by a wide range of prostaglandins at a concentration of 20 micrograms/ml. Of the PGs present in semen, PGE2, PGE3 and PGF2alpha had no significant effects whereas PGE1 and PGF1alpha significantly increased lactate accumulation and the latter increased oxygen uptake, in both cases without significantly changing fructose utilization, fructose oxidized or CO2 production. Both 15-methyl-substituted PGE2 and PGF2alpha and their corresponding methyl esters failed to change fructose metabolism and it is unlikely therefore that the lack of response to PGE2 and PGF2alpha was due to their being metabolized by the spermatozoa during the incubation. Of a number of breakdown products tested, PGA1 and to a lesser extent PGA2 appeared to inhibit the Krebs tricarbocyclic acid cycle and 15-keto 13,14-dihydro-PGF2alpha appeared to stimulate it. In general, epididymal spermatozoa responded to the PGs in the same way as ejaculated spermatozoa. Thus we did not confirm a suggestion in the literature that spermatozoa have lowered sensitivity to PGs in vitro once they have been in contact with the PGs in seminal plasma.

Animals↗

PubMedDate not supplied

Correlative study of the ultrastructure and the physiology of the seasonal regression of the epididymal epithelium in the hedgehog Paraechinus micropus.

The seasonal variations in the ultrastructure and physiology of the epididymis of hedgehog were studied in relation to the reproductive functions. Five adult male hedgehogs were sacrificed every alternate month for one calendar year and the epididymis was fixed in Bouin's, Zenker and formol-calcium for light microscopy and in cold buffered glutaraldehyde, post-fixed in osmium tetraoxide for electron microscopy. The epididymal epithelium consists of four types of cells, the principal, the apical, the dark and the basal cells. The principal cells like other steroid synthesizing cells, contain the extensive Golgi apparatus, the smooth and the rough endoplasmic reticulum (SER and RER), the secretory vesicles and the lipid granules during the breeding season, but they are practically devoid of these cell organelles during regression, except for the retarded Golgi and moderate RER. The basal cell, on the other hand, show lipids and well developed organelles during regression but poorly developed structure in the sexually active hedgehog and possibly function as the cells storing lipids during regression and which are subsequently used at the beginning of the recrudescence. The epididymal epithelium recrudesces along with the seminiferous epithelium prior to the spermatozoa reaching the epididymal lumen, whereas the accessory sex glands which are also the extratesticular androgen dependent organs, still show regressed structure. Thus, the ultrastructural and the physiological observations suggest that the principal cells are probably the site of androgen synthesis and they become fully developed along with the cells in the testis on stimulation from the pituitary at the beginning of the recrudescence.

Animals↗

PubMedDate not supplied

Effect of chloroquine on the motility and acetylcholinesterase activity of porcine spermatozoa during epididymal maturation.

The development of motility in porcine spermatozoa as well as the acetylcholinesterase activity of porcine testicular and epididymal spermatozoa in response to chloroquine stimulation were studied. Spermatozoa acquired the capacity for progressive motility as they moved along the epididymis, reaching their peak motility in the caudal portion of the epididymis. Spermatozoal acetylcholinesterase activity declined drastically from the testis to the caput epididymis after which subsequent decline became gradual. Chloroquine stimulation of testicular and epididymal spermatozoa remarkably enhanced sperm motility and the rate of loss of acetylcholinesterase activity only in spermatozoa obtained from the caudal portions of the epididymis. The results indicate that the development of sperm motility during sperm maturation is accompanied by a decline in sperm acetylcholinesterase activity and that the physiological maturity of epididymal sperm could be enhanced by chloroquine stimulation.

Acetylcholinesterase↗

PubMedDate not supplied

Impaired epididymal function in patients with detached ciliary tufts in semen: a preliminary report.

Low spermatozoal ATP concentration in the presence of high alpha-glucosidase activity may indicate efficient epididymal function. It was suggested that detached ciliary tufts (DCTs) originated from the epididymis. We compared the spermatozoal ATP concentration and alpha-glucosidase activity in semen of patients with DCTs to that of a control group. Higher ATP concentration and lower alpha-glucosidase activity were found in patients with DCTs in their semen compared to the control group. These results might probably point out impaired epididymal function and further support the proposed epididymal origin of these tufts.

Adenosine Triphosphate↗

PubMedDate not supplied

Bovine epididymal sperm proacrosin-acrosin system: quantification and partial characterization.

Several studies suggest that acrosin, an acrosomal trypsin-like serine proteinase, plays a role in fertilization. The enzyme is present in an enzymatically inactive precursor form, called proacrosin and is believed to be converted to the enzymatically active form(s) through one/multiple physiological event(s) prior to the sperm penetration of the zona pellucida. Although, the proacrosin-acrosin system of several species has been well documented, the study of the enzyme system in bovine caput and cauda epididymis (where the maturation of spermatozoa occurs) has not been characterized. The present study demonstrates the quantification and partial characterization of the proacrosin-acrosin proteinase system in unpurified acrosomal extracts of bovine caput and cauda epididymal sperm. Proacrosin activation followed the sigmoidal type of activation curve. Activation experiments demonstrate that almost 80-90% of this protein exists in zymogen (proacrosin) form either in ejaculated or caput and cauda epididymal spermatozoa. Time-course activation studies showed that the zymogen in isolated spermatozoa was completely converted to active non-zymogen form in 3 and 5 h after removal from the cauda and caput regions, respectively, at pH 8.0 at 25 degrees C. This conversion was markedly inhibited by calcium in a dose dependent manner and the inhibition was reversible. On the other hand, calcium has a stimulatory effect on the hydrolytic activity of acrosin. These studies reveal that the proacrosin-acrosin system can be identified in crude extracts of bull epididymal and ejaculated sperm.

Acrosin↗

PubMed1986

Influence of lowered temperature upon the response of prostatic and epididymal portion of the rat isolated vas deferens to field stimulation.

This paper reports the effects of lowering (bath) temperature upon contractile responses of prostatic and epididymal ends of the rat isolated vas deferens to electrical field stimulation. Responses to field stimulation with single pulses at 60 s intervals were potentiated by lowering the bath temperature. This effect was maximal at temperatures of 25-27 degrees C and was reduced in preparations treated with phentolamine (5 mumol/l). Field stimulation with trains of 50 pulses at 5 Hz every 5 min produced biphasic contractions of preparations. The initial, twitch-like component, prominent at the prostatic end and resistant to blockade by phentolamine (5 mumol/l) was little affected by lowering the bath temperature from 37.5 degrees C to 19 degrees C. In contrast, the second, more prolonged, component of the response to pulse trains, which was prominent at the epididymal end of the tissue was decreased by lowering the bath temperature and by phentolamine. In the epididymal segment, responses to exogenous noradrenaline were enhanced by lowering the bath temperature. It is concluded that lowering the bath temperature enhances the contractility of the vas deferens in response to the release of neurotransmitters and to the application of exogenous noradrenaline via a postsynaptic action. In addition, via a presynaptic action, lowering the bath temperature depresses or delays the release of the noradrenergic transmitter from the sympathetic nerve terminals.

Animals↗

PubMed2004

Torsion of an epididymal cyst.

Torsion of an epididymal cyst is a very rare condition. We present a case of torsion of an epididymal cyst in a 13-year-old boy. The patient presented with acute scrotal pain. Scrotal ultrasonography showed a 38 x 35 x 30 mm fluid-filled mass within the caput of the left epididymis. Histologically, the cells of the epididymal duct were necrotic. To our knowledge, this is the second case report in the literature.

Adolescent↗