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International Journal of Transgender... 2020: One of the more common procedures conducted through the transition-related surgeries (TRSs) program is simple orchiectomy. Due to the relative novelty of TRS in...
: One of the more common procedures conducted through the transition-related surgeries (TRSs) program is simple orchiectomy. Due to the relative novelty of TRS in Canada, national perioperative guidelines for simple orchiectomy in the context of TRS are yet to be developed. Furthermore, there is a void in the literature describing the indications and outcomes of simple orchiectomy among transgender individuals. : This study is the first descriptive case series in Canada highlighting our experience with simple orchiectomy in the context of TRS. : This study retrospectively assessed data from electronic patient medical records of 16 patients who had simple orchiectomy procedures at Women's College Hospital in Toronto, Canada from August 2018 to April 2019. Data were collected using a standardized data collection form which includes patient baseline demographic data, and objective and subjective clinical outcomes. : Mean age at surgery was 32.6 ± 10.4 years and mean time to surgery following the initial approval of referral was 9.9 ± 8.5 weeks. A majority of referrals ( = 13, 81.3%) were from urban areas with specialized TRS services. The average time on hormones was 3.1 ± 1.9 years. In terms of post-surgical complications at the 30-day day follow-up visit, there was a single post-operative sperm granuloma reported. There were no other complications identified post-surgery in our patient case series. : In Ontario, the growing recognition of the benefits of TRS has led to the development of a publicly funded pathway to TRS surgery. This study is the first assessment of simple orchiectomy performed for TRS in Canada, and it has shown that the procedure is safe and reproducible. Due to its benefits, coordinating safe and efficient access of care for this procedure should be an important action item for health systems. This study is limited by its low sample size.
PubMed: 34993518
DOI: 10.1080/26895269.2020.1774030 -
Urology Case Reports Mar 2020Sperm granuloma is a common finding following vasectomy, with majority of the lesions located at the site of the vasectomy defect. Sperm granulomas are typically small...
Sperm granuloma is a common finding following vasectomy, with majority of the lesions located at the site of the vasectomy defect. Sperm granulomas are typically small and asymptomatic. We describe a case in which the nodule presented similarly to a supernumerary testis by radiographic features.
PubMed: 31867216
DOI: 10.1016/j.eucr.2019.101080 -
Scientific Reports Nov 2019Male meiotic germ cell including the spermatozoa represent a great challenge to the immune system, as they appear long after the establishment of normal immune tolerance...
Male meiotic germ cell including the spermatozoa represent a great challenge to the immune system, as they appear long after the establishment of normal immune tolerance mechanisms. The capacity of the testes to tolerate autoantigenic germ cells as well as survival of allogeneic organ engrafted in the testicular interstitium have led to consider the testis an immunologically privileged site. Disruption of this immune privilege following trauma, tumor, or autoimmune orchitis often results in male infertility. Strong evidence indicates that indoleamine 2,3-dioxygenase (IDO) has been implicated in fetal and allograft tolerance, tumor immune resistance, and regulation of autoimmune diseases. IDO and tryptophan 2,3-dioxygenase (TDO) catalyze the same rate-limiting step of tryptophan metabolism along a common pathway, which leads to tryptophan starvation and generation of catabolites collectively known as kynurenines. However, the relevance of tryptophan metabolism in testis pathophysiology has not yet been explored. Here we assessed the in vivo role of IDO/TDO in experimental autoimmune orchitis (EAO), a model of autoimmune testicular inflammation and immunologically impaired spermatogenesis. EAO was induced in adult Wistar rats with testicular homogenate and adjuvants. Control (C) rats injected with saline and adjuvants and normal untreated rats (N) were also studied. mRNA expression of IDO decreased in whole testes and in isolated Sertoli cells during EAO. TDO and IDO localization and level of expression in the testis were analyzed by immunostaining and Western blot. TDO is expressed in granulomas from EAO rats, and similar protein levels were observed in N, C, and EAO groups. IDO was detected in mononuclear and endothelial cells and reduced IDO expression was detected in EAO group compared to N and C rats. This phenomenon was concomitant with a significant reduction of IDO activity in EAO testis measured by tryptophan and kynurenine concentrations (HPLC). Finally, in vivo inhibition of IDO with 1-methyl-tryptophan increased severity of the disease, demonstrating down regulation of IDO-based tolerance when testicular immune regulation was disrupted. We present evidence that an IDO-based mechanism is involved in testicular immune privilege.
Topics: Animals; Autoimmune Diseases; Disease Models, Animal; Epididymis; Immune Privilege; Indoleamine-Pyrrole 2,3,-Dioxygenase; Kynurenine; Lymph Nodes; Male; Orchitis; Rats; Rats, Wistar; Sertoli Cells; Severity of Illness Index; Testis; Tryptophan; Tryptophan Oxygenase
PubMed: 31685866
DOI: 10.1038/s41598-019-52192-8 -
Toxicologic Pathology Dec 2019The 2019 annual National Toxicology Program Satellite Symposium, entitled "Pathology Potpourri," was held in Raleigh, North Carolina, at the Society of Toxicologic...
The 2019 annual National Toxicology Program Satellite Symposium, entitled "Pathology Potpourri," was held in Raleigh, North Carolina, at the Society of Toxicologic Pathology's 38th annual meeting. The goal of this symposium was to present and discuss challenging diagnostic pathology and/or nomenclature issues. This article presents summaries of the speakers' talks along with select images that were used by the audience for voting and discussion. Various lesions and topics covered during the symposium included aging mouse lesions from various strains, as well as the following lesions from various rat strains: rete testis sperm granuloma/fibrosis, ovarian cystadenocarcinoma, retro-orbital schwannoma, periductal cholangiofibrosis of the liver and pancreas, pars distalis hypertrophy, chronic progressive nephropathy, and renal tubule regeneration. Other cases included polyovular follicles in young beagle dogs and a fungal blood smear contaminant. One series of cases challenged the audience to consider how immunohistochemistry may improve the diagnosis of some tumors. Interesting retinal lesions from a rhesus macaque emphasized the difficulty in determining the etiology of any particular retinal lesion due to the retina's similar response to vascular injury. Finally, a series of lesions from the International Harmonization of Nomenclature and Diagnostic Criteria Non-Rodent Fish Working Group were presented.
Topics: Animals; Humans; Pathology; Toxicology
PubMed: 31645210
DOI: 10.1177/0192623319876929 -
International Braz J Urol : Official... 2019
Topics: Epididymis; Granuloma; Humans; Male; Middle Aged; Spermatozoa; Testicular Diseases; Ultrasonography
PubMed: 30901170
DOI: 10.1590/S1677-5538.IBJU.2018.0676 -
Proceedings of the National Academy of... Feb 2019Cilia are cell-surface, microtubule-based organelles that project into extracellular space. Motile cilia are conserved throughout eukaryotes, and their beat induces the...
Cilia are cell-surface, microtubule-based organelles that project into extracellular space. Motile cilia are conserved throughout eukaryotes, and their beat induces the flow of fluid, relative to cell surfaces. In mammals, the coordinated beat of motile cilia provides highly specialized functions associated with the movement of luminal contents, as seen with metachronal waves transporting mucus in the respiratory tract. Motile cilia are also present in the male and female reproductive tracts. In the female, wave-like motions of oviductal cilia transport oocytes and embryos toward the uterus. A similar function has been assumed for motile cilia in efferent ductules of the male-i.e., to transport immotile sperm from rete testis into the epididymis. However, we report here that efferent ductal cilia in the male do not display a uniform wave-like beat to transport sperm solely in one direction, but rather exert a centripetal force on luminal fluids through whip-like beating with continual changes in direction, generating turbulence, which maintains immotile spermatozoa in suspension within the lumen. Genetic ablation of two miRNA clusters ( and ) led to failure in multiciliogenesis in murine efferent ductules due to dysregulation of numerous genes, and this mouse model allowed us to demonstrate that loss of efferent duct motile cilia causes sperm aggregation and agglutination, luminal obstruction, and sperm granulomas, which, in turn, induce back-pressure atrophy of the testis and ultimately male infertility.
Topics: Animals; Cilia; Epididymis; Female; Genitalia, Male; Humans; Infertility, Male; Male; Mice; Mice, Knockout; MicroRNAs; Microtubules; Spermatozoa; Testis
PubMed: 30659149
DOI: 10.1073/pnas.1817018116 -
Journal of Surgical Case Reports Jan 2019Sperm cell granuloma, also termed epididymitis nodosa, is a form of chronic epididymitis that occurs secondary to inflammation, trauma, and/or a vasectomy. We present a...
Sperm cell granuloma, also termed epididymitis nodosa, is a form of chronic epididymitis that occurs secondary to inflammation, trauma, and/or a vasectomy. We present a rare such case that to our knowledge is unique in pediatric literature: a 13-year-old boy presented with clinical and sonographic findings of epididymo-orchitis. At first, the boy was admitted for a short course of conservative treatment and was discharged. Symptoms deteriorated, he was readmitted and surgery revealed a non-twisted testis, with normal vas and vessels that ended in a necrotic testicular parenchyma. Histology showed a case of epididymitis nodosa and ruptured sperm granuloma that caused vascular compression, thrombosis and testicular necrosis. Epididymitis nodosa should be considered in cases of testicular swelling when clinical course is unusual and conservative treatment fails.
PubMed: 30631422
DOI: 10.1093/jscr/rjy349 -
Reproductive Medicine and Biology Oct 2018In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction... (Review)
Review
BACKGROUND
In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception.
METHODS
This article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches.
MAIN FINDINGS
The reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot-assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery.
CONCLUSION
In the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.
PubMed: 30377390
DOI: 10.1002/rmb2.12207 -
Journal of the American Veterinary... May 2018
Topics: Animals; Breeding; Cattle; Cattle Diseases; Diagnosis, Differential; Granuloma; Lameness, Animal; Male; Orchiectomy; Sperm Count; Testicular Neoplasms; Ultrasonography
PubMed: 29701522
DOI: 10.2460/javma.252.10.1217 -
Comparative Medicine Apr 2018Providing social housing for adult male macaques can be challenging. One successful strategy for long-term social housing of adult male macaques is to pair them with...
Providing social housing for adult male macaques can be challenging. One successful strategy for long-term social housing of adult male macaques is to pair them with adult females; however, unwanted breeding must be prevented by sterilization of the male or female. Vasectomy is a simple, highly effective, and minimally invasive method of contraception that is used at our institution to facilitate social housing. We performed a retrospective review to analyze the surgical outcomes and rate of postoperative complications after vasectomy of adult rhesus macaques at our research facility. In addition, we evaluated the success rate of pairing vasectomized macaques with female partners. Over 10 y, 16 macaques were vasectomized, of which 5 developed postoperative complications such as orchitis, epididymitis, or surgical site infection. These complications resolved completely and without incident after antibiotic and analgesic therapy; an additional male had postoperative incisional swelling that resolved quickly after NSAID treatment. This complication rate is consistent with that in humans by surgeons who perform open vasectomies relatively infrequently. In addition, 5 of the vasectomized macaques (31%) developed sperm granulomas, which are a common and generally benign complication in humans and have been reported to develop in 40% of macaques after vasectomy. Successful pair housing with a female partner was achieved for 13 of 16 (81%) of the vasectomized macaques. We conclude that surgical vasectomy is a safe and simple procedure that can be used as a highly effective method to facilitate social housing of adult male rhesus macaques in research facilities.
Topics: Animals; Behavior, Animal; Female; Housing, Animal; Macaca mulatta; Male; Retrospective Studies; Treatment Outcome; Vasectomy
PubMed: 29663943
DOI: No ID Found