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Results of microsurgical epididymal sperm aspiration (MESA) ans testicular sperm extraction (TESE) in azoospermic men using intracytoplasmic sperm injection (ICSI).

The rationale and results of using epididymal and testicular spermatozoa with intracytoplasmic sperm injection (ICSI) for zoospermic patients are reviewed. A total of 128 consecutive ICSI/MESA cycles and a total of 120 consecutive ICSI/TESE cycles were performed up to December 1994. The two-pronuclei fertilization rate per intact oocyte (observed after the injection) was 58% and 60%, respectively, when epididymal and testicular spermatozoa were used. The embryo transfer rate was similar for the two procedures (91% after ICSI/MESA and 90% after ICSI/TESE). Fifty women became pregnant (positive HCG) when epididymal spermatozoa were used (39% per cycle and 40% per embryo transfer). These results are comparable to those obtained when ejaculated spermatozoa are used.

Cell Separation↗

Indications for corticosteroids prior to epididymal sperm retrieval.

OBJECTIVE: To evaluate the effectiveness of low-dose intermittent prednisone treatment designed to reduce antisperm antibodies for men prior to epididymal sperm retrieval and in vitro fertilization. STUDY DESIGN: This was a retrospective review of 75 subfertile men with reproductive obstruction due to congenital absence of the vas deferens, or other reproductive tract obstruction, who underwent a total of 98 episodes of microsurgical epididymal sperm aspiration (MESA) with in vitro fertilization. RESULTS: For couples in whom the man was pretreated with prednisone, better fertilization rates (39% vs. 21%, P < .0001) and pregnancy rates (48% vs. 26%, p = 0.06) were obtained than in couples in whom the man was not pretreated. The benefit of prednisone treatment was most noticeable for men with preoperatively detectable antisperm antibodies. Prednisone-treated men with preoperative antisperm antibodies showed improved fertilization rates (40% vs. 9%, p = 0.005). Men without antibodies who were treated with prednisone showed a decrement in fertilization rate, from 73% to 24% (fertilizations per oocyte, P < .0005). Success of prednisone treatment could not be correlated with specific assisted-reproduction technique (IVF, PZD, SuZI, or ICSI). CONCLUSIONS: Preoperative evaluation of antisperm antibody status and treatment of antibody-positive men prior to epididymal sperm retrieval may play a role in improvement of the fertilization and pregnancy results achieved by centers that provide MESA with assisted reproduction. These results are most important when MESA is performed without the assistance of intracytoplasmic sperm injection. Empiric treatment with prednisone may be detrimental to the fertility of men who have no antisperm antibodies.

Adult↗

Segmental hemorrhagic infarction of testis associated with epididymitis.

Testicular infarction is most commonly associated with acute testicular torsion. We present the sonographic findings in a case of segmental testicular infarction associated with epididymitis. The gray-scale abnormalities included a round, well-defined, hypoechoic intratesticular mass and heterogeneity and enlargement of the epididymis. Color Doppler sonography demonstrated only minimal blood flow in the intratesticular mass and increased flow in the epididymis. Recognition of acute testicular segmental infarction as a complication of epididymitis may prevent unnecessary orchiectomy.

Adult↗

Relationship between the association of rat epididymal protein "DE" with spermatozoa and the behavior and function of the protein.

Rat epididymal glycoprotein DE associates with the dorsal region of the sperm head during sperm maturation, migrates to the equatorial segment (ES) with the acrosome reaction (AR), and is involved in gamete membrane fusion. In the present study we examined the association of DE with the sperm surface and the relationship of this interaction with the behavior and function of the protein. Cloning and sequencing of DE revealed a lack of hydrophobic domains and the presence of 16 cysteine residues in the molecule. Experiments in which cauda epididymal sperm were subjected to different extraction procedures indicated that while most of the protein is removable from sperm by mild ionic strength, a low amount of DE, resistant to even 2 M NaCl, can be completely extracted by agents that remove integral proteins. However, the lack of hydrophobic domains in the molecule and the failure of DE to interact with liposomes, does not support a direct insertion of the protein into the lipid bilayer. These results, and the complete extraction of the tightly bound protein by dithiothreitol, suggest that this population would correspond to a peripheral protein bound to a membrane component by strong noncovalent interactions that involve disulfide bonds. While ELISA experiments showed that no protein could be extracted by NaCl from capacitated sperm, indirect immunofluorescence studies revealed the ability of the NaCl-resistant protein to migrate to the ES. Together, these results support the existence of two populations of DE: a major, loosely bound population that is released during capacitation, and a minor strongly bound population that remains after capacitation, migrates to the ES with the AR, and thus would correspond to the one with a role in gamete fusion.

Animals↗

Detection of Chlamydia trachomatis by the polymerase chain reaction in young patients with acute epididymitis.

Specimens from 11 patients presenting with acute epididymitis were tested for the presence of Chlamydia trachomatis by an enzyme immunoassay (EIA), growth in McCoy cells and the polymerase chain reaction (PCR), and for other microorganisms by standard laboratory techniques. Chlamydia trachomatis urethral infection was detected in four patients by tissue culture, in three patients by EIA and in nine patients by PCR. These findings confirm the usually low detection rate of Chlamydia trachomatis by conventional tissue culture and EIA. Detection by PCR indicated both the diagnostic value of this technique and the importance of this organism in epididymitis.

Acute Disease↗

Müllerian duct cyst as a cause of acute infantile-onset epididymitis.

Müllerian duct cyst is a congenital anomaly that originates from remnants of the müllerian duct that usually regresses in utero. It is most commonly detected in adult males during the third and fourth decades of life. Müllerian duct cyst is rarely reported in infants less than 1 year of age, in whom diagnosis is difficult because of immaturity of the genital tract. In this case report, we describe the sonographic and CT appearance of a large intrapelvic müllerian duct cyst presenting with acute epididymitis in a 9-month-old infant. The embryological basis, imaging findings and relation to epididymitis are discussed.

Cysts↗

Emphysematous epididymitis as presentation of unusual seminal vesicle fistula secondary to sigmoid diverticulitis: case report.

This case report describes a sigmoid diverticulitis with torpid development, long-term symptoms of bladder irritability, and an emphysematous epididymitis caused by a direct seminal vesicle fistula. The diagnosis was suggested by scrotal ultrasound visualizing gas in the scrotum; the complex pelvic fistulous tract was specifically delineated by multislice computed tomography. This may be the first reported case of seminal vesicle fistula directly related to colonic diverticulitis and causing emphysematous epididymitis.

Aged↗

Tuberculous epididymitis associated with abdominal lymphadenopathy (2004:1b).

Although the predominant form of tuberculosis is pulmonary disease, an increasing number of cases with extra-pulmonary involvement have been reported. The diagnosis of extra-pulmonary tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory findings. Abdominal lymph node involvement may be present alone or in combination with involvement of the gastrointestinal tract, peritoneum, and solid viscera. Tuberculous epididymitis occurs sporadically and represents a specific secondary subacute or chronic inflammatory process involving the epididymis. We present the imaging findings in a patient with tuberculous epididymitis associated with abdominal tuberculous lymphadenopathy.

Adult↗

Epididymal calcification in genital filariasis.

Although calcification of the epididymis has been described occasionally in the histologic sections of sperm granuloma, epididymal tuberculosis, and filarial funiculoepididymitis, it has not been demonstrated radiologically. Two cases of epididymal calcification due to long-standing genital filariasis are presented. Both the patients presented with chronic bilateral funiculoepididymitis, and in one secondary sterility also developed due to destruction and calcification of both the epididymides. Calcification of the epididymis in filariasis appears to be due to calcification of the dead adult filarial worm. Radiologic demonstration of this calcification would help to differentiate various types of funiculoepididymitis.

Adult↗

Mouse submandibular glands express an androgen-regulated transcript encoding an acidic epididymal glycoprotein-like molecule.

Acidic epididymal glycoprotein (AEG) is an androgen-regulated, epididymal secretory protein assumed to be involved in sperm maturation. In the present study, we show that the mouse submandibular gland (SMG) expresses two genes designated Aeg-1 and Aeg-2. The nucleotide sequence of Aeg-1 cDNA clones was identical to that of epididymis-expressed Aeg cDNA clones, indicating that Aeg-1 is expressed in both epididymides and SMGs. The second, more abundant transcript, Aeg-2, had a sequence similar to, but distinct from, that of Aeg-1, and was not detectable in the epididymis. The level of Aeg-1 and Aeg-2 transcripts in the SMG was androgen-regulated and showed sexual dimorphism. In situ hybridization of SMG sections showed that Aeg-1 and Aeg-2 transcripts are produced by the cells of granular convoluted tubules. The C-terminal cysteine-rich region of the mouse AEG-2 molecule appears to have diverged faster than that of the mouse AEG-1 molecule, consistent with the idea that this region may play a role unique to the protein of the male reproductive system.

Amino Acid Sequence↗

Ovine contagious epididymitis: a review.

Ovine contagious epididymitis is predominantly associated with Brucella ovis, Actinobacillus seminis and a variety of organisms including Histophilus ovis. Transmission occurs venereally or by homosexual activity and, in the case of Actinobacillus seminis, ewe to lamb transmission is probably important. A chronic infection, mainly in the cauda epididymis may result in formation of spermatic granulomata and a reduction in ram fertility. Eradication of ovine brucellosis can be achieved by serological testing using a complement-fixation test in conjunction with palpation of lesions and removal of reactors. Vaccination to control ovine brucellosis is advocated in some countries. The nomenclature of the group of Gram-negative pleomorphic organisms to which Actinobacillus seminis and Histophilus ovis belong is urgently in need of review. This paper reviews the organisms capable of producing ovine contagious epididymitis, the pathogenesis of the condition as well as methods of diagnosis and control.

Actinobacillus Infections↗

Three cases of xanthogranulomatous epididymitis caused by E. coli.

Xanthogranulomatous epididymitis is an uncommon but benign process, characterized by tissue destruction and the accumulation of abundant foamy macrophages mixed with lymphocytes and plasma cells. The pathogens generally found to cause xanthogranulomatous inflammation have been Proteus and E. coli. We identified such a pathogen by sequencing divergent regions of 16S rRNA, followed by pathogen-specific-PCR using alr, ipaH, ial, and iuc primer pairs in DNA microdissected from an H&E stained slide. We report here three cases of xanthogranulomatous epididymitis caused by E. coli.

Aged↗

Tuberculous epididymitis with extensive retroperitoneal and mediastinal involvement.

The incidence of tuberculosis in the United States is on the rise, in part, because of its association with acquired immunodeficiency syndrome. Genitourinary tuberculosis remains one of the most common forms of secondary or extrapulmonary disease. We present an unusual case of tuberculous epididymitis with extensive retroperitoneal and mediastinal spread. The possible routes of dissemination, as well as the efficacy of antimycobacterial therapy in the management of tuberculous epididymitis, are discussed and the relevant literature is reviewed.

Adult↗

Cytomegalovirus epididymitis following renal transplantation.

Cytomegalovirus infection is an important cause of morbidity and mortality in immunocompromised individuals. The disease is usually systemic in expression although localized infection can occur, particularly in the lung, liver, retina and gastrointestinal tract. We report a case of cytomegalovirus epididymitis with limited systemic manifestations occurring 2 months after renal transplantation in a patient immunosuppressed with azathioprine, prednisone and cyclosporine. Diagnosis was confirmed by observation of typical cytopathic changes in epididymal cells. Clinical resolution occurred with epididymo-orchiectomy and 9-(1,3-dihydroxy-2-proproxymethyl)guanine therapy. To our knowledge this presentation has not been described previously in the transplant literature and it is extremely rare in other forms of inherited or acquired immune deficiency.

Antiviral Agents↗

Tuberculous epididymitis occurring 35 years after renal tuberculosis.

An unusual case of tuberculous epididymitis occurring 35 years after renal tuberculosis is reported. The possible mechanisms of this delayed presentation of the epididymal lesion are discussed. This case emphasizes the importance of adequate treatment as well as long-term followup of patients with genitourinary tuberculosis.

Aged↗

A prospective study of antisperm antibody development in acute epididymitis.

The association between acute epididymitis and development of antisperm antibodies was investigated by the gelatin agglutination technique in prospectively collected serum samples from 27 patients. Agglutinating antisperm antibodies, mainly of the IgG class, were detected in seven men (27 per cent), a significantly increased frequency compared to prevalences previously found among blood donors and men from infertile couples. The antibodies developed de novo in four patients (15 per cent). The increased incidence of positive sera and the kinetics of the antibody responses strongly indicate a causal link between acute epididymitis and autoimmunization against spermatozoa. In the majority of the patients the antibody titers were low, being of only theoretical importance in respect to later fertility.

Adult↗

Ectopic ureter presenting with epididymitis in childhood: report of 5 cases.

We report 5 cases of an ectopic ureter opening into the seminal tract. All of the patients presented with the clinical features of acute or chronic epididymitis. Our experience has shown that the rare occurrence of epididymitis in prepubertal children necessitates a complete urological evaluation and that an underlying urological problem, including an ectopic ureter, should be sought.

Child↗

Acute epididymitis in boys: a 5-year retrospective study.

A retrospective study was undertaken of 25 children with epididymitis seen at our pediatric hospital during the last 5 years. The symptoms and signs in these patients were evaluated, as well as the results of urinalysis, urine culture, excretory urogram, scrotal scan, exploration and white blood count. The presence of underlying urological problems was particularly sought for and found to be rare prior to epididymitis. The treatment and results are reviewed.

Acute Disease↗