Further experiences with an alloplastic spermatocele: experiements in bulbs.
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Animals↗
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[Implantation of an alloplastic spermatocele in obstructive azoospermia].
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Adult↗
[Artificial silicone elastomer spermatocele. Experimental study].
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Epididymis↗
Alloplastic spermatocele: epididymal reservoir using artificial material.
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Animals↗
New development in surgical andrology. Alloplastic spermatocele.
We developed a cup-shaped silicone-dacron prosthesis that may be used as a sperm reservoir. Spermatozoa aspirated from this reservoir and stored as pellets in liquid nitrogen for 6 weeks induced pregnancies and normal births in 50 per cent of inseminated cows. Because of aplasia or long stenosis of the vas deferens 26 prostheses were implanted upon the epididymis in 14 patients. Percutaneous aspirations up to 7 months postsurgery showed 0.3 to 105 million spermatozoa the quality and quantity of which decreased with time. Insemination of patients' wives has not resulted in pregnancy.
Animals↗
Alloplastic spermatocele: 20 years experience and perspectives.
Reconstructive interventions on the seminal pathways are impossible in cases of vas aplasia, longer vas obstructions and ejaculatory disorders as paraplegia or diabetes mellitus. For these groups of patients there has been no further therapy until recently to fulfil their desire to father a child.
Adult↗
Pigment epithelium-derived factor, a human testis epididymis secretory product, promotes human prostate stromal cell growth in culture.
PURPOSE: We identified and characterized unrecognized testicular secretory proteins that impact human prostate growth. MATERIALS AND METHODS: Human spermatocele fluid served as a source of testicular epididymal secretions and prostatectomy specimen benign prostatic hyperplasia stromal cells as the in vitro prostate growth promoting effects indicator. RMPI plus medium supplemented with 10% fetal bovine serum MALDI-TOF, MS FBS and ITS+ (Collaborative Research-Becton Dickinson, Bedford, Massachusetts) served as positive and negative controls, respectively. Whole and fractionated spermatocele fluid or specific proteins without and with select polyclonal or monoclonal antibodies were added to routine 6-day cultures. The observation of significantly increased 6-day cell counts compared with appropriate controls (p <0.05) was judged to reflect cell growth. Amino acid microsequencing and MALDI-TOF MS sequence analysis were done on persistent protein bands from active spermatocele fluid fractions. RESULTS: Whole and fractionated human spermatocele fluid increased stromal cell culture numbers significantly. Sequence analysis of 47 and 17 kDa 1-dimensional gel bands in the final active fraction identified a major peptide with sequence homology to human pigment epithelium-derived factor (PEDF). The presence of PEDF was confirmed by Western blot analysis. Addition of recombinant PEDF to incomplete medium significantly increased stromal cell culture number. PEDF antibodies neutralized or markedly decreased the stromal stimulating effect of spermatocele fluid and PEDF. CONCLUSIONS: The observations presented provide evidence for human testis/epididymis secretion of PEDF and for a PEDF in vitro growth promoting effect on benign prostatic hyperplasia stroma. The concept that testicular epididymal secretory proteins may influence normal and abnormal prostate growth warrants continued consideration.
Body Fluids↗
Tubular ectasia of the testicle: sonographic and MR imaging appearance.
OBJECTIVE: Ectasia of the seminiferous tubules at the level of the mediastinum is a recently recognized benign condition of the testicles. Although it may have typical sonographic features, the condition can at times be difficult to distinguish from tumors on the basis of sonography. We describe the sonographic and MR appearance of this condition in seven men in whom we were able to distinguish tubular ectasia from tumors of the testicles on the basis of the imaging findings. MATERIALS AND METHODS: Ectasia of the seminiferous tubules was histologically proved in a man who had an intratesticular mass seen on sonograms and MR images. We analyzed the sonographic and MR imaging features in this man and in six others who had similar imaging findings but did not have biopsy proof of tubular ectasia. RESULTS: The first patient was a man with bilateral findings who had a unilateral orchiectomy that revealed ectasia of the seminiferous tubules. Spermatocelectomy was performed in another man whose testis was normal on surgical inspection and on subsequent follow-up. Imaging findings have remained unchanged in one man with 3-year imaging follow-up and in three men with clinical follow-up of 8-22 months. One patient was lost to follow-up. At presentation, most of the men were more than 55 years old. All had a scrotal mass typical of a spermatocele on physical examination, with normal testes when the testes could be palpated. The spermatocele was larger than 4 cm in six of 11 involved epididymides. On imaging, in five of the seven patients, the intratesticular process was bilateral, involved the mediastinum testis, began at the periphery adjacent to the spermatocele, and extended for a variable distance within the testis. On sonograms, the lesion was hypoechoic with coarse internal echoes. MR imaging of six of the seven patients showed characteristic findings and allowed the identification of two additional testicles with tubular ectasia that were missed sonographically. Lesions had a homogeneous signal similar to that of the coexisting spermatocele with all pulse sequences. They were hypointense relative to the testis on T1- and proton density-weighted images and, unlike tumors, were not visible on T2-weighted images. CONCLUSION: Our experience suggests that ectasia of the seminiferous tubules can be distinguished from testicular tumor on the basis of characteristic clinical, sonographic, and MR imaging findings. Thus, orchiectomy is unnecessary to establish the diagnosis and to rule out tumor.
Diagnosis, Differential↗
The treatment of obstructive azoospermia in male infertility--past, present, and future.
Until recently, the primary treatment option for infertile men with obstructive azoospermia was the reconstruction of the male seminal tract when the causes of obstruction were reconstructable. For unreconstructable causes, such as congenital absence of the vas deferens, the primary treatment option involved implantation of an alloplastic artificial spermatocele for subsequent percutaneous retrieval of sperm. Retrieved sperm was then used for intrauterine insemination. The introduction of in vitro fertilization (IVF), performed together with microsurgical epididymal sperm aspiration (MESA), provided new frontiers for the treatment of unreconstructable obstructive azoospermic infertility in men. Against this background, the author reviewed the past and present status of the treatment of obstructive male infertility for the purpose of seeking a future course for the treatment of obstructive azoospermia. At the Andrology Clinic, 246 (26%) of 963 infertile males revealed azoospermia and 72 (29%) of these 246 patients showed obstruction at the seminal tract, showing that 7.5% of male infertility cases were caused by ductal obstruction. Microsurgical reconstruction of the seminal tract was performed, including vasovasostomy (29 cases), epididymovasostomy (18 cases), and artificial spermatocele implantation (20 cases). Vasovasostomy resulted in an 81.3% patency rate and a 37.5% fertility rate. Epididymovasostomy showed a 71% patency rate and a 29% fertility rate. In contrast, artificial spermatocele implantation resulted in positive sperm present in the aspirated fluid in 33.3% of the patients; however, no pregnancy was achieved by artificial insemination using aspirated sperm. MESA together with assisted reproductive technology (ART) in 14 patients showed 79% ovum fertilization rates and a 35.7% clinical pregnancy rate. Thus, this new technique could open new frontiers for the future treatment of obstruction of the male seminal tract which cannot be reconstructed by vasovasostomy or vasoepididymostomy.
Epididymis↗
Efficacy of microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI) in obstructive azoospermia.
PURPOSE: Our purpose was to test whether micromanipulation using subzonal insemination and intracytoplasmic sperm injection could improve the poor fertilization and pregnancy rates obtained when attempting in vitro fertilization in patients with congenital absence of the vas deferens and unreconstructable obstructive azoospermia with microsurgically retrieved epididymal spermatozoa. RESULTS: Conventional in vitro fertilization (group A; 14 cycles), subzonal insemination (group B; 13 cycles), and intracytoplasmic sperm injection (group C; 28 cycles) were carried out in 55 treatment cycles. Fertilization rates for groups A, B, and C were 16.1, 31.4, and 48.6%, respectively (P < 0.05). Clinical pregnancy rates for groups A, B, and C were 7.1, 7.7, and 32.1% (P < 0.05), respectively. In five cycles, intracytoplasmic sperm injection using epididymal sperm from alloplastic spermatoceles was performed and two clinical pregnancies (40%) were obtained. CONCLUSIONS: The combined microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection procedure is highly effective in improving the fertilization and pregnancy rate in congenital absence of the vas deferens and unreconstructable obstructive azoospermia. Furthermore, alloplastic spermatoceles may be useful for repeat sperm aspirations.
Epididymis↗
A population based assessment of complications following outpatient hydrocelectomy and spermatocelectomy.
PURPOSE: We determine the incidence of complications following outpatient scrotal surgery for the treatment of hydroceles and spermatoceles. MATERIALS AND METHODS: A retrospective study of all patients undergoing hydrocelectomy or spermatocelectomy between April 1, 1997 and March 31, 1999 at 1 institution was performed. The hospital and office charts were reviewed, and postoperative complications (infection, persistent swelling, chronic pain) were recorded. The type of preoperative antiseptic preparation (iodine based versus chlorhexidine) and the presence or absence of surgical drains were also recorded. RESULTS: A total of 161 patients were included in the study with an average age of 53.7 years. The overall complication rate was 19.2%. Infection/scrotal abscess formation occurred in 9.3% of patients, persistent swelling (treatment failure) in 9.3% and chronic pain in 0.6%. There was no significant difference in the complication rate when the preoperative preparations and the presence or absence of surgical drains were compared. CONCLUSIONS: The most common complications following scrotal surgery for hydroceles and spermatoceles are persistent scrotal swelling, inflammation and postoperative infection. Further prospective investigation is required to study factors such as the use of drains, preoperative and/or perioperative antibiotics and the type of surgical preparations, which may have a role in complication rates.
Adolescent↗
Diagnostic value of scrotal sonography in infertile men: report on 658 cases.
Scrotal sonography with a 7.5 MHz sector scanner was performed on 658 consecutive patients of our infertility clinic. The incidence of pathological findings was unexpectedly high. Forty per cent of the patients revealed pathological structures such as varicoceles (21%), hydroceles (7%), epididymal abnormalities (6%), spermatoceles (6%), intratesticular hyper- and hypoechoic changes (4.5%), intratesticular cysts (1%) and tumours or carcinoma in situ (CIS) (0.6%). Sonographic evaluation and measurement of the caput epididymidis was compared with palpation. Sonography distinguished size ranges of "normal" and "thickened" epididymides as diagnosed by palpation. Cystic structures were proven in 56% of cases with "thickened" epididymides. The sonographically determined diameters of doppler-negative blood vessels were significantly smaller than those of doppler-positive vessels. Sonography revealed a higher occurrence of varicoceles than diagnosed by palpation (76% by palpation). Only 58% of sonographically identified hydroceles and only 67% of sonographically detected spermatoceles were detected by palpation. One testicular tumour and one case with CIS were only seen by sonography and not suspected on palpation. The results demonstrate that sonography represents a valuable tool in the routine diagnosis of andrological patients.
Adult↗
Metallothionein in human seminal plasma.
Metallothionein (MT) concentrations were measured in the seminal plasma of 4 fertile and 35 infertile men and in the hydrocele and spermatocele fluids. The relationship between MT content and sperm density, total number of sperm per ejaculate, sperm motility and abnormal form rates, leukocyte count and zinc levels in seminal plasma, as well as the relationship between MT and serum follicle-stimulating hormone, luteinizing hormone, testosterone, and prolactin were examined. MT was not detected in the hydrocele and spermatocele fluids. MT levels were related to zinc levels and to the leukocyte count in seminal plasma, but there was no correlation between MT and the other factors examined. This study supported previous findings that MT was secreted predominantly from the prostate and induced by inflammation of the prostate gland or seminal vesicles; the findings suggest that MT binds mainly to zinc and is one of the zinc-binding proteins in seminal plasma.
Adult↗
Congenital absence of the vas deferens.
Fourteen personal cases of agenesia of the vas deferens, bilateral in 12 and unilateral in 2, are described. In 13 of the cases the diagnosis was confirmed by surgical exploration. In most of the cases cytologic examination of aspiration biopsy specimens and histologic examination of surgical specimens of the testes showed that spermatogenesis was normal. The appearance of biopsy specimens of the epididymides were normal except for a certain degree of interstitital fibrosis and dilation of the ductus epididymidis. Endeavours to produce an artificial spermatocele with the aid of an isolated flap of tunica vaginalis in several patients proved unsuccessful. In one patient with a naturally preformed spermatocele the latter was aspirated, and the patient's wife was inseminated with the cellular content from the aspirate. This procedure has been repeated on several occasions, but so far without any subsequent conception. The failure of treatment of these patients may perhaps be due to some change in the function of their epididymides. This possibility is discussed.
Atrophy↗
[Tubular ectasia of the rete testis. The echographic aspects].
Tubular ectasia of the seminiferous tubules of the rete testis is an uncommon benign condition which was only recently described. Its US pattern is typical and allows the disease to be distinguished from cystic tumors of the testicle. The condition was evaluated with US in 10 patients; all men were over 50 years old. US was performed with a 7.5-MHz linear probe. The lesion was unilateral in 7 and bilateral in 3 patients. It was always localized in the mediastinum testis and was associated with spermatocele in 5 cases and with testicular cysts in 4. On US scans, the condition presented with several tubular or rounded anechoic structures, mimicking a hypoechoic mass. In 5 men with 4-19 months' follow-up, no change in lesion size and structure was observed. Tubular ectasia was never assessed with biopsy or histology. Tubular ectasia of the rete testis shares several US features with testicular cysts and spermatocele, which are likely to have the same underlying mechanisms. This benign condition can be distinguished from true cysts and testicular tumors on the basis of US findings and its differential diagnosis is important to avoid unnecessary surgery.
Aged↗
Extratesticular lesions: a radiological and pathological correlation.
It is often difficult to make an exact pathological diagnosis of extratesticular lesions detected on ultrasound. This study aimed to clarify the sonographic criteria required for a more accurate diagnosis by performing a correlative study of the ultrasonographic findings and pathologic diagnosis. Of the 268 scrotal ultrasound examinations with extratesticular lesions reviewed, 81 had the diagnosis confirmed on pathological or clinical grounds. The major pathological entities reviewed in the study were epididymitis, hydrocele, cystic lesions of the epididymis, post-vasectomy lesions and solid extratesticular lesions. The sonographic appearances in both acute and chronic epididymitis were reviewed. Clinical epididymitis had a typical clinical presentation and distribution confined to the epididymal tail and ductus deferens. This should allow a specific diagnosis to be made. Cystic lesions of the epididymis included true epididymal cysts and spermatoceles, but these entities were not distinguishable from each other sonographically. Late complications of vasectomy have been recognized clinically as the 'Late Post-Vasectomy Syndrome', and the pathological changes have also been described. In this study the corresponding sonographic appearances of sperm granulomata, dilated efferent ducts and spermatoceles are documented. Most solid extratesticular lesions are areas of fibrosis termed 'fibrous pseudotumours', but adenomatoid tumours and papillary cystadenomata are the most common neoplastic lesions. By obtaining pathological correlations for many sonographic extratesticular abnormalities, we have clarified a number of issues and made several new observations.
Cysts↗
[Study on the fertility of epididymal sperms].
One approach to the treatment of obstructive azoospermic cases in whom either vasovasostomy cannot be performed or the vas deferens is absent is to construct an artificial spermatocele in the epididymis. By using this method to recover sperms for use in AIH, we have succeeded in achieving pregnancy in only 2 of 35 cases, leading us to investigate the fertility of the recovered sperms. Sperm fertility was investigated by the hypoosmotic swelling (HOS) test, observation by confocal laser-scanning microscope (CLSM), flow cytometry and hamster egg sperm penetration test. The percentage of swollen sperm determined by the HOS test was 15.0-83.3%, with a mean of 47.6 +/- 16.1%, significantly lower than the values of the normal group and the infertile male group, excluding cases of obstructed azoospermia. Examination by confocal laser-scanning microscope of samples stained with PI and FITC-PSA or PI and FITC-Con A stain revealed viable and dead spermatozoa as well as viable and dead acrosome-reacted spermatozoa. In addition, fertility was evaluated from the distribution of spermatozoa in each area from the flow cytometry percentage. This method was shown previously to be useful for the evaluation of fertility as it demonstrated the presence of numerous spermatozoa in the fertile area of cases who did not succeeded in pregnancy. The hamster egg sperm penetration test yielded a fertility rate of 0-25% with a mean of 8.2 +/- 10.0%, which was significantly lower than the value of the normal group, but was not significantly different from the infertile group. The findings of this study indicated that the fertility of epididymal sperms is low, thereby pointing to the need for studies to improve the materials used in the artificial spermatocele as well as the method of sperm recovery. Furthermore, our findings suggest that flow cytometry may be used to select the epididymal sperms with the highest fertility for sperm recovery.
Animals↗
Surgical treatment of obstructive azoospermia.
The records of 325 azoospermic patients were reviewed. A total of 109 patients (33.5%) had obstructive azoospermia and 48 of them underwent surgical treatment. Three patients had vas deferens agenesia and underwent artificial spermatocele; 14 with epididymal obstruction were treated by an end-to-end microsurgical vasoepididymostomy; and 31 vasectomized patients were submitted to microsurgical reversal. There was no pregnancy in the spermatocele patients. In the vasoepididymostomy patients 60% became patent and 30% achieved pregnancy. In the reversal group 90% of patency and pregnancy rate of 80% were observed, in a mean follow-up of 21 months. The last 8 cases were treated with a biological glue and 7 showed patency and one pregnancy in a 3-month follow-up period. One was lost to follow-up.
Adult↗