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Vasectomy and vasovasostomy. I. Timing of histologic changes in immature and mature dog testis after vasectomy.

The effects of vasectomy on the development and maintenance of spermatogenesis was studied using immature and mature dog testes. Bilateral vasectomy in immature dogs delayed the development of advanced spermatocytes, spermatids, and spermatozoa for about 3 months postsurgery. Spermatogenesis appeared to be recovered to control levels by 4 months postvasectomy. Spermatogenesis in mature dogs was also altered after bilateral vasectomy. Decreased numbers of advanced spermatocytes as well as maturation arrest was observed by 3 weeks postvasectomy. Seminiferous tubule cell layers quickly decreased to one to three layers as the lumina became occluded with sloughed cells by 3 to 6 weeks postvasectomy. Recovery in terms of the numbers of spermatocytes, spermatids, and spermatozoa was evident by 13 weeks postvasectomy, although occasional dog testes did not recover and appeared to be more sensitive to vasectomy-induced damage. It thus appears that vasectomy temporarily inhibits both the development and maintenance of spermatogenesis in immature as well as mature dog testes. Spermatogenesis does recover but may be maintained at somewhat lower levels after vasectomy. Changes are rapid in onset and take several weeks to be reversed. Some dog testes appear to be more sensitive to the damage and it may be irreversible in these testes.

Animals

Comparison of allergic aspermatogenesis with that induced by vasectomy. II. In vitro studies of cell-mediated immunity to sperm after vasectomy in man and guinea-pig.

Transformation of peripheral blood leucocytes was shown to be a valid assay for cell-mediated immunity to sperm in male guinea-pigs immunized with homologous epididymal sperm (ES) in FCA. A heat-treated extract of ES (BES) was used for culture. Possible developement of cell-mediated immunity to sperm after vasectomy was investigated in patients and guinea-pigs, by culture of blood leucocytes before and at intervals after operation. Patients' leucocytes were cultured with a heat-treated extract of human seminal sperm (BHS); guinea-pigs' leucocytes were cultured with BES. These cultures showed no evidence of specific stimulation of leucocytes by sperm extract, up to 1 year after vasectomy in patients, or up to 6 months in guinea-pigs. Similarly, no evidence of delayed hypersensitivity could be demonstrated by skin tests with BES in animals vasectomized 1 year previously. We consider that this study establishes that cell-mediated immunity to sperm does not develop in either man or guinea-pigs, up to 1 year after conventional vasectomy.

Animals

Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal.

Twenty-eight men undergoing vasectomy reversal who were found to have no sperm in the proximal vas fluid on one or both sides underwent microscopic epididymal exploration. In 33 of 39 cases so explored, normal sperm were found in the epididymal fluid of the corpus, despite absence of sperm in the vas fluid. Epididymal histology distal to this site revealed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scanty fluid. It is concluded that persistent azoospermia after an accurate microscopic vasovasostomy results from the secondary epididymal obstruction induced by rupture of the epididymal duct related to the pressure increase after vasectomy.

Adult

Endocrine effects of vasectomy.

In order to provide information on the endocrine effects of vasectomy, unconjugated pregnenolone, dehydroepiandrosterone, androstenedione, testosterone, dihydrotestosterone, oestrone and oestradiol were analysed in the blood plasma of twenty Mexican men on two occasions before and 1, 3, 6 and 12 months after vasectomy. Vasectomy appeared to be associated with a significant decrease in the plasma levels of pregnenolone, dehydroepiandrosterone and androstenedione and a significant increase in the levels of dihydrotestosterone and oestrone. A probably significant increase in oestradiol levels took place 12 months after vasectomy but not before. No consistent changes were found in testosterone (up to 12 months) or in FSH and LH levels (up to 6 months) after vasectomy. The unconjugated steroids indicated above, except oestrone, were also estimated, whenever possible, in seminal plasma specimens obtained from thirty-nine subjects (including the twenty indicated above) on the same occasions. Vasectomy was associated with a highly significant decrease of seminal plasma dihydrotestosterone levels on all occasions and a significant decrease in androstenedione levels after 6 and 12 months. After 12 months there was a decrease in dehydroepiandrosterone and an increase in oestradiol; these changes were both probably significant. In another preliminary study, the levels of pregnenolone sulphate, dehydroepiandrosterone sulphate, testosterone glucuronide, testosterone sulphate and dihydrotestosterone sulphate were estimated before and 1 month after vasectomy in the seminal plasma of fourteen to seventeen subjects. Testosterone glucuronide fell, probably significantly, but other conjugates were unchanged. The data indicate that vasectomy may be associated with significant changes in the circulating and in seminal plasma levels of several steroids. The gradual nature of some of the changes observed suggests the necessity of conducting in several centres large-scale, long-term studies on vasectomized subjects and on a carefully matched control group. During the last decade vasectomy has been widely practised in several parts of the world as a method of fertility control. However, information on the endocrine effects of this intervention appears to be scanty. In most of the human studies reported, a small number of individuals were investigated and the studies have been confined to the assessment of the short-term effects of the operation. Moreover, the hormonal indices assessed by the various investigators have been limited, in most cases, to gonadotrophins and testosterone in blood. The present study was designed to assess in the same subjects the levels of a number of unconjugated steroids, FSH and LH on two occasions before and 1, 3, 6 and 12 months after vasectomy. The studies were extended to include steroid analyses in seminal plasma in the hope that such assays might yield information as to the effects of vasectomy on the distribution of steroids in the fluids of the male reproductive tract.

Adult

A long-term study of mortality in men who have undergone vasectomy.

BACKGROUND: Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health. METHODS: We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not. RESULTS: Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level. CONCLUSIONS: Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study.

Adult

Human sperm antigens and antisperm antibodies I. Studies on vasectomy patients.

This study documents the types and incidence of antisperm antibody, detectable by indirect immunofluorescence, in 114 patients before vasectomy, 112 at 2 months and 71 patients at 6-9 months after vasectomy. Indirect immunofluorescence techniques revealed antibodies to seven distinct sperm antigens. Five of these antigens were readily accessible to antibody in vitro, and the remaining two were accessible only after treatment of spermatozoa with dithiothreitol and trypsin. Antisperm antibodies were detected in 61% of patients before vasectomy. The incidence rose to 77% at 2 months and 90% at 6-9 months after vasectomy. These antibodies were distinguishable into two groups based on their incidence before vasectomy. The first group included antibodies to antigens in the acrosome with a diffuse distribution, the equatorial region, the postacrosomal region and the midpiece of the tail. Its incidence was 61% before vasectomy; increased to 73% at 2 months and 80% at 6-9 months after vasectomy. The second group included antibodies to the sperm nucleus, the tail and to discrete antigens over the acrosome. They were found rarely (3%) in patients before vasectomy; increased in incidence to 25% at 2 months and 55% at 6-9 months after vasectomy. Antisperm antibodies of both groups existed as IgG and IgM classes; an exception being antibodies to sperm nucleus which were almost exclusively IgG. Of the antibodies, 14% were found to fix complement in vitro. Other autoantibodies, including antinuclear, antimitochondrial and antismooth muscle antibodies, did not develop following vasectomy.

Acrosome

The effects of vasectomy on the testis and accessory sex glands of the Hartley strain guinea pig.

The short term effects of bilateral vasectomy on the testis and the accessory sex glands of the guinea pig were compared with the effects of sham operation and unilateral vasectomy at 3, 5, 7, and 9 weeks after operation. The testis weights, sorbitol dehydrogenase activity, histology, epididymal sperm number, and motility were recorded. Accessory sex glands were weighed and chemically analyzed for fructose and citric acid content. The citric acid concentration of the dorsolateral prostate of the bilateral vasectomy group was significantly higher than concentrations in sham-operated and unilateral vasectomy groups at 3 weeks only. This may indicate transient hormonal derangement as a result of vasectomy. No significant differences were noted between testes of vasectomy and sham-operated groups. The unligated side testes of the unilateral vasectomy group were different from the testes of vasectomy and sham-operated groups. We conclude that interruption and ligation of the vas deferens itself has no effect on the testis of the guinea pig. Furthermore, all vasectomy experiments should include sham-operated controls.

Animals

Incidence of disease after vasectomy: a record linkage retrospective cohort study.

OBJECTIVE: To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation. DESIGN: Retrospective cohort study using linked medical record abstracts. SETTING: Six health districts in Oxford region. SUBJECTS: 13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for one of three specified elective operations, appendicitis, or injuries. MAIN OUTCOME MEASURES: Hospital admission and death after vasectomy or comparison event. RESULTS: The mean durations of follow up were 6.6 years for men with a vasectomy and 7.5 years for men with a comparison condition. The relative risk of cancer of the testis in the vasectomy cohort (4 cases) compared with that in the other cohorts (17 cases) was 0.46 (95% confidence interval 0.1 to 1.4), that of cancer of the prostate (1 v 5 cases) 0.44 (0.1 to 4.0), and that of myocardial infarction (97 v 226 cases) 1.00 (0.8 to 1.3). There was no evidence of an increase associated with vasectomy in the incidence of a range of other diseases. CONCLUSIONS: Vasectomy was not associated with an increased risk of testicular cancer or the other diseases studied. With respect to prostatic cancer, while we found no cause for concern, longer periods of observation on large numbers of men are required.

Adult

Biochemical and histological changes in testes and epididymis of dog after vasectomy.

1. Changes in the histological structure and biochemical composition have been studied in the testes and epididymis of dog after unilateral and bilateral vasectomies. 2. Testes and epididymis weight did not change after 30 days of unilateral vasectomy. Whereas a significant decrease was observed after 60 and 120 days of unilateral and bilateral vasectomy. Tests and epididymis weights returned to normal after 180 days of bilateral vasectomy. 3. Histologically testes and epididymis were normal after 30 days of vasectomy. After 60 and 120 days of unilateral and bilateral vasectomy. Testes and generative changes. Seminiferous tubule and Leydig cell nuclear diameter reduced. Sixty to seventy percent tubules recover after 180 days of bilateral vasectomy. 4. Decrease in RNA, protein, sialic acid contents and increase in alkaline phosphatase activity, total lipids, cholesterol coincided with the absence of spermatozoa and atrophic changes in the testes. 5. The early degenerative changes were caused due to back pressure of testicular fluid (Vare et al, 1973).

Alkaline Phosphatase

Sperm agglutinins in seminal plasma and serum after vasectomy: correlation between immunological and clinical findings.

The development of sperm agglutinins in serum and seminal plasma in relation to vasectomy was studied in forty-seven men by testing samples taken before vasectomy and on five occasions during the first year after vasectomy. Thirty additional patients were tested only 1 year after vasectomy. One year after vasectomy, sperm agglutinins in the serum in titres from 4 to about 4000 had developed in 62% of the entire group, while antibodies in the seminal fluid detectable by the gelatin agglutination test were present in only 4% of the group, and apart from on unusual case the titres were low here (either 4 or 8). Analysis of the modes of agglutination revealed changing patterns in several patients during the observation period, with a predominance of tail agglutinins after 1 year. In some cases, mixed agglutination was seen with serum but pure tail-to-tail agglutination with seminal plasma. The total number of spermatozoa in a pre-vasectomy ejaculate was found to be correlated with an early immune response and with the titre values after 1 year. The group of patients in whom agglutinins had developed 1 year after vasectomy were found to have significantly larger nodules at the sites of operation than those without sperm agglutinins.

Agglutinins

Sperm granuloma and reversibility of vasectomy.

Ninety-two consecutive patients who had undergone bilateral vasectomy 1 month to 28 years earlier were studied at the time of vasectomy reversal for sperm output, dilatation of the vas-deferens lumen, and sperm granuloma. Thirty-nine men had unilateral or bilateral sperm granuloma. The presence of of a sperm granuloma virtually assured normal sperm in the vas fluid no matter how long ago the vasectomy was performed. In the absence of a sperm granuloma, the interval since vasectomy had an important influence on the quality of vas fluid. The presence of a sperm granuloma was associated with significantly less dilatation of vas-deferens lumen at the testicular end. The site of the vasectomy and the amount of vas deferens removed did not influence sperm quality. A sperm granuloma on only one side resulted in normal spermatozoa in the vas fluid on that side, whereas the side without the sperm granuloma had abnormal spermatozoa or no spermatozoa in the vas fluid. It is concluded that when sperm granuloma follows vasectomy it vents the high pressure otherwise created by vasectomy and prevents disruption of sperm output in the vas fluid.

Adult

A comparison of open-end versus closed-end vasectomies: a report on 6220 cases.

This study was done to determine if there was a difference in results when both vas ends were closed or when the prostatic end was closed and the testicular end left open. The author performed 6220 vasectomies between June 1, 1972 and June 1, 1992. The first series consisted of 3081 vasectomies in which both ends of the vas deferens were closed. The second series consisted of 3139 vasectomies in which the testicular end of the vas deferens was left open while the prostatic end only was closed. No portion of the vas was excised. Congestive epididymitis was diagnosed in 6% of cases utilizing closed-end vasectomy and 2% of cases where the open-end vasectomy was performed. Open-end vasectomy is recommended because the incidence of congestive epididymitis is reduced.

Epididymitis

Micropuncture and microanalytic studies of the effect of vasectomy on the rat testis and epididymis.

Micropuncture techniques adapted for in vivo use in the male reproductive tract were used to study the effect of vasectomy on the concentration and morphology of spermatozoa in the seminiferous tubules and ductus epididymidis of the rat. Regardless of surgical technique, 85% of all rats which had previously under vasectomy developed a speratic granuloma at the proximal end of the ligated vas deferens. Vasectomy did not affect the weights of the ipsilateral (vasectomized) testes. Vasectomy without granuloma formation resulted in an elevation in the weight of the ipsilateral epididymis and an increase in the concentration of spermatozoa in the ipsilateral cauda. Vasectomy complicated by granuloma formation caused a significant increase in the ratio of the spermatocrit in the seminiferous tubule to that in the caput. In the vasectomized rat without granuloma, significantly more abnormal spermatozoa were in the caput than in the cauda; in the normal rat, the concentrations of abnormal spermatozoa in the two regions were not significantly different. Vasectomies with and without granuloma formation are distinct phenomena and should be investigated separately.

Animals

Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia.

The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.

Canada

Effect of irrigation of vas deferens on sperm analyses after vasectomy.

70 men were operated for voluntary sterilisation by vasectomy alone and 20 men by vasectomy and irrigation of distal vasa with acid Kystosol solution. Postoperative semen analyses 2 weeks later showed azoospermia in only 2% of cases after vasectomy alone and in 25% of cases following vasectomy and irrigation, and 2 months postoperatively in 44% and 90%, respectively. Non-motile sperm cells in seminal analyses was the most common finding in both series 2 weeks after vasectomy. The problem whether the non motile sperm cells are viable or not is discussed. However, two azoospermic semen analyses must be obtained before sterility after vasectomy can be ascertained.

Cell Count

Chronic testicular pain following vasectomy.

The incidence of chronic testicular pain following vasectomy has not been previously assessed. We have carried out a survey by postal questionnaire and telephone interview of 172 patients 4 years after vasectomy to assess the incidence of chronic testicular pain. Significant early post-operative complications occurred in 6 patients (3.5%): 2 infection, 3 haematoma and 1 orchitis. Chronic testicular discomfort was present in 56 patients (33%), considered by 26 (15%) to be troublesome but not by the other 30 (17%). Testicular discomfort related to sexual intercourse occurred in 9 cases (5%). Of the 9 patients who had sought further medical help only 2 had had further surgery (1 an epididymectomy and 1 excision of a hydrocele). Only 3 patients regretted having had the vasectomy because of chronic pain. On ultrasound examination, epididymal cysts were a common finding on both asymptomatic and symptomatic patients following vasectomy. Prior to vasectomy, all patients should be counselled with regard to the risk of chronic testicular pain.

Adult