[Microsurgery in the reconstruction of the vas deferens. Experimental study].
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Sperm number and condition affect the number of basal cells and their expression of macrophage antigen in the murine epididymis.
Unilateral ligation of the mid-corpus epididymis, the proximal vas deferens and imposition of an abdominal temperature for 6 days as well as bilateral castration for 3, 6 or 14 days, resulted in a change in epithelial composition of the adult murine epididymis with regard to the number and antigen expression of basal cells. There were fewer basal cells per tubule cross-section with fewer expressing F4/80 antigen when spermatozoa were absent from the proximal lumen following short-term castration. Conversely, more basal cells with more of them demonstrating macrophage antigen expression were evident when more or damaged spermatozoa were in the proximal lumen after corpus ligation and exposure to abdominal temperature or in the cauda after long-term withdrawal of androgen support. By contrast, ligation of the vas deferens did not lead to tubule distension, and hence sperm accumulation, and did not alter the basal cell population in the cauda epididymis. The data suggest that epididymal basal cells respond in number and macrophage antigen expression to the presence of sperm autoantigens in the lumen with little dependence on circulating androgens. These changes may represent responses to minimise the interaction of sperm autoantigens with the immune system and the risk of immunological infertility.
Animals↗
Pain after vasectomy.
We studied the influence of the timing of injection of bupivacaine into the vas deferens on the intensity and duration of scrotal pain following vasectomy. Forty-two patients undergoing vasectomy under general anaesthesia were randomly allocated to have the operation performed on either the left or the right side first. On the first side to be operated upon, 5 ml bupivacaine 0.5% was infiltrated along the line of the scrotal incision. The vas deferens was identified and 1 ml bupivacaine 0.5% was injected into its lumen, with 0.5 ml directed proximally and 0.5 ml directed distally. After completion of the procedure on that side, the operation continued on the other side. On this occasion, the same dose of bupivacaine was injected into the vas deferens after division and ligation, and subcutaneously along the scrotal incision after skin closure. Median [interquartile range] visual analogue pain scores on the first side to be operated upon were significantly lower than on the second side on day 1 (7 [1.5-19] vs. 11 [2.5-47]) (p < 0.01) and day 7 (0 [0-8.5] vs. 0 [0-18.8]) (p < 0.05) postoperatively. The median [interquartile range] duration of postoperative discomfort was less on the first side operated upon than on the second (3 [1-7] vs. 6 [2-7]) (p < 0.01). Although statistically significant differences occurred between the treatment groups, the actual differences were small and may not be clinically significant.
Adult↗
The lessons of vasectomy-a review.
Vasectomy has become the most common method of permanent male sterilization for birth control. It is a simple operation that requires approximately 20 minutes to perform. Under local anaesthesia the vas deferens is cut and ligated. The patient is considered sterile when the ejaculate is sperm-free. Since spermatogenesis is not arrested by the operation and since the normal route of sperm removal is blocked, other mechanisms of sperm removal are developed. These mechanisms include sperm resorption into the interstitial tissue, granuloma formation, phagocytosis and immune response to sperm antigens. More than half of the men subjected to vasectomy develop demonstrable antibodies to one or more sperm antigens. Having been induced by the individual's own untreated antigen without the aid of external adjuvants, the response justifies the most rigorous definition of autoimmunity. The wide scale use of vasectomy, therefore, provides the clinical immunologist with a unique opportunity to study a longstanding, induced autoimmune response in otherwise normal human subjects. It is a matter of special importance to study these subjects carefully, in order to learn the maximum about human autoimmunity.
Autoantibodies↗
Ligation of the testicular artery and vein in adolescent varicocele.
Proper surgical management of adolescent varicocele is controversial. Recent evidence suggests that the Palomo approach gives the best results. We report on the outcomes of 43 consecutive adolescent boys who underwent operative correction of varicocele by a single surgeon from 1979 to 1992. An inguinal approach with ligation of the vascular pedicle above the vas deferens (modified Palomo) was used in each case. From 1979 to 1983 an attempt was made to preserve the testicular artery but it was successful in only 6 of 12 cases. After 1983 no further attempt was made to preserve the artery and, therefore, 37 patients underwent total ligation of the vascular pedicle above the entry of the vas deferens into the spermatic cord. Most of the varicoceles were grade II. Significant discrepancy in testicular volume (10% difference) constituted the main indication for operation. The ipsilateral (left) testis was smaller in 30 of 37 patients (81%). Of those testes with size discrepancy 90% showed significant volume increase following surgery. Many left testes assumed the same volume as the normal right testis. The only surgical failure (recurrence) of the 43 cases occurred in 1 of the 6 in which artery preservation was successful. There were no surgical failures in the group of 37 boys. Mean followup is 3.7 years. Total ligation of the testicular vascular pedicle seems to afford catch-up growth for smaller ipsilateral testes with low risk for recurrence of the varicocele.
Adolescent↗
Prepubertal vasal injury: its effect on postpubertal vas deferens.
At this institution, via clinical observation at laparoscopy, a phenomenon was noted in humans that was associated with injury to the prepubertal vas deferens. There were 4 cases that presented with apparent atrophy of the abdominal pelvic portion of the vas deferens following injury to the vas in the prepubertal period. A study was undertaken to see if this phenomenon could be duplicated in an animal model. Prepubertal Sprague-Dawley rats were selected and divided into several groups ranging from sham surgery to unilateral partial vasectomy. These groups allowed for observations following different modes of trauma as well as creation of a control population. Additionally, an adult group was studied to evaluate the effects of vas injury in the adult rat. In the adult group, following trauma to the vas, no changes in the abdominal pelvic portion of the vas were noted. In the prepubertal group, with ligation and with segmental excision (partial vasectomy), striking diminution in outer diameter and wall thickness of the distal vas deferens was noted. This study indicates that the rat prepubertal vas serves as a good model for study of the human vas deferens. Further studies are underway which seek to elicit the mechanism of the observed injury.
Animals↗
Varicocele: a multidisciplinary approach in children and adolescents.
PURPOSE: To minimize varicocele treatment in children and adolescents a multidisciplinary approach that includes surgery and operative radiology has been used at our institution since 1991. We present our results during this 7-year period. MATERIALS AND METHODS: From January 1991 to December 1997 we examined 477 patients 4 years 5 months to 25 years 4 months old (mean age 13 years 3 months) with varicocele, of whom 367 (396 varicoceles) required treatment. Percutaneous sclero-embolization was suggested as the primary treatment of choice in all cases, while surgery was reserved for select cases. A total of 366 cases followed at least 6 months (mean 1 year) were entered into this study. RESULTS: Only 7.1% of the patients or families preferred surgery. In 47 patients sclero-embolization was not possible due to technical problems or vascular anomalies. Sclero-embolization was successful in 79.4% of 277 patients, and retroperitoneal ligation was successful in 88.7% of 124. Since 1995 ligation of the whole spermatic bundle above the vas deferens has been preferred, and only 1 recurrence has been observed in 60 cases. CONCLUSIONS: Percutaneous sclero-embolization is a minimally invasive treatment of varicocele that is feasible in children and adolescents. Most patients prefer this therapy, although it is not as safe as surgery. When open surgery is required, complete ligation of the whole vascular pedicle above the vas deferens offers excellent success.
Adolescent↗
[Influence of an injection of chorionic hormone (HCG) on the accumulation of testicular fluid following ligature of the vas deferens in adult Wistar rats].
Using the weight gain of the testis after efferent duct ligation, we have measured the testis fluid secretion. A single injection of HCG to Rats before, at the time or after the ligation leads to three types of effects: no effect which can be explained by the metabolisation of the hormone: a positive and/or a negative one. If the stimulating action of HCG remains unexplained, it must be related with ether anaesthesia. It seems likely that the decrease of testicular fluid secretion may represent the fundamental action of HCG upon the exocrine function of the testis, but the mecanism by which this action occurs remains to be solved.
Animals↗
Congenital absence of the vas deferens.
Absence of a vas deferens is a marker for more serious anomalies of the genitourinary tract. It is highly probable that the ipsilateral kidney, ureter or bladder is deformed or absent. The complete physical examination and the preoperative examination for vasectomy should include palpation to identify the vas. The existence of an accessory vas could explain failure of azoospermia following a ligation procedure.
Humans↗
Sperm antibodies after vasectomy with fulguration.
Whether antisperm antibodies develop after vasectomy probably depends on several variables, 1 of which may be the surgical technique. The levels of serum antisperm antibodies were compared in men vasectomized by 1 techniques: vasoligation and fulguration. No difference in the incidence of spermagglutinating antibody was found in the 2 groups. However, immobilizing antibodies were observed in 43 per cent of the men undergoing vasoligation but in only 29 per cent of the men vasectomized by fulguration.
Agglutinins↗
Effect of 4-chloromethyl-2-methyl-2-pentyl- 1,3-dioxolane (AY-22,352) on the fertilizing ability of hamster epididymal spermatozoa.
Fertile male hamsters were injected subcutaneously with AY-22,352 to determine the minimal antifertility dose, the site of action and the onset and duration of infertility. Fertility tests showed that 37 mg AY-22,352/kg/day induced sterility within 4 days. None of the males became infertile within the first 2 days but marked loss of sperm fertilizing ability had occurred by 24 hr from the second injection; all males were sterile after the fourth dose. Comparable daily treatment procuded the same antifertility effect subsequent to bilateral ligation of the corpus epididymidis and fertilization did not occur after artificial insemination with spermatozoa from the cauda epididymidis of such animals. The prompt recovery of fertilizing ability of spermatozoa in males which receoved four daily doses of AY-22,352 (37 mg/kg) and had ligated ductuli efferentes shows that transport of epididymal spermatozoa and their acquisition of fertilizing ability are not influenced by the drug.
Animals↗
[Experimental vasectomy: comparison of epididymal structure with various surgical techniques].
OBJECTIVE: To analyze the effects of different surgical techniques of vasectomy on the epididymal structure. METHODS: Experimental vasectomies were performed in dogs using the conventional and open-ended techniques. The animals were orchidectomized 1 to 12 months after vasectomy and the epididymal structure was analyzed. RESULTS: The epididymal structure of dogs submitted to the conventional technique showed marked ectasia, reinforced basement membrane, loss of stereocilia in the principal cells, and formation of spermatic granulomas in interstitial tissue. At 12 months the principal cells showed signs of degenerative changes. In the different time periods analyzed in the study, no changes were observed in the epididymal structure of dogs submitted to the open-ended technique. CONCLUSIONS: The changes observed in the principal cells are ascribable to the increased intraluminal pressure produced by ligation of both ends of the vas deferens (conventional technique), since no changes were found in the epididymal structure of dogs submitted to the open-ended technique, at least in the different time periods analyzed in the study.
Animals↗
[Vasectomy and tubal ligation: medicopsychological aspects of voluntary sterilization].
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Ambulatory Care Facilities↗
Physician attitudes and practices studied in Sao Paulo, Brazil.
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Americas↗
Sterilization regret among women in metropolitan Montreal.
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Adolescent↗
[Medico-legal risks of human voluntary sterilization].
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Adult↗
Factors associated with married women's selection of tubal sterilization and vasectomy.
Multivariate analyses of data from 248 married women scheduled for tubal sterilization and 165 wives of men scheduled for vasectomy indicated that male and female sterilization methods were selected for different reasons and under different circumstances. More specifically, the woman who underwent tubal sterilization was more likely to have perceived that she had greater influence than her husband over the sterilization decision, to have had cesarean section or vaginal delivery in association with sterilization, to have chosen tubal ligation because her spouse refused to undergo the alternative procedure or because it was convenient to combine it with delivery or other surgery, and to have had a spouse who was unwilling to be sterilized because of possible side effects associated with vasectomy. The woman whose husband underwent vasectomy was more likely to have been very fearful of surgery in general or especially fearful of reproductive surgery, to have known many men who already had had a vasectomy, to have perceived that her husband was more strongly motivated than herself to terminate childbearing, to have had a spouse who participated in birth control, and to have chosen vasectomy because it was easier or less expensive or because her physician advised against tubal sterilization.
Adult↗
Epididymal obstruction during development results in antisperm autoantibodies at puberty in rats.
An autoimmune response to sperm occurs after vasectomy, but there is little information on whether similar reactions occur after obstruction of the male reproductive tract at other points. Male Lewis rats received bilateral ligation of the corpus epididymidis or a sham operation at age 10 days, and the subsequent systemic antisperm autoantibody responses were compared to those observed following obstruction of the vas deferens. After sexual maturation, rats with epididymal ligations had antisperm antibodies on an enzyme-linked immunosorbent assay that were significantly higher than those of sham-operated animals and did not differ from antibody levels in vasectomized rats at the same ages. Western blot analysis showed that certain sperm proteins were recognized by antisperm antibodies after both epididymal ligation and vasectomy, including the previously identified "dominant" autoantigens at 73-83, 68-72, 48, 42, and 22 kDa. On the other hand, sera from rats with epididymal ligations recognized 60 and 52 kDa proteins that were not bound by most postvasectomy sera. Conversely, 42-48 and 38-42 kDa bands were more strongly and frequently stained after vasectomy than after epididymal ligation. The results demonstrate that antisperm antibodies are produced after obstruction of the epididymis and that the magnitude of the response is comparable to that after vasal obstruction. Differences in autoantigens recognized after epididymal and vasal obstructions may reflect maturational changes in sperm components that take place during the passage of spermatozoa through the epididymis.
Animals↗