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Asian Journal of Andrology Jan 2013This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy (VE) in patients with epididymal obstructive...
This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy (VE) in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm (>10(4) ml(-1)) in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men (58.8%), including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.
Topics: Adult; Anastomosis, Surgical; Azoospermia; Epididymis; Humans; Male; Microsurgery; Semen Analysis; Sperm Count; Suture Techniques; Sutures; Treatment Outcome; Urologic Surgical Procedures; Vas Deferens
PubMed: 23042447
DOI: 10.1038/aja.2012.100 -
Journal of Cytology Jul 2011The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology...
BACKGROUND
The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital.
AIM
This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis.
MATERIALS AND METHODS
A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate.
RESULTS
Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosis
CONCLUSIONS
Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.
PubMed: 21897542
DOI: 10.4103/0970-9371.83463 -
Proceedings of the National Academy of... May 2011Vasectomy is a well accepted global contraceptive approach frequently associated with epididymal granuloma and sperm autoantibody formation. To understand the long-term...
Vasectomy is a well accepted global contraceptive approach frequently associated with epididymal granuloma and sperm autoantibody formation. To understand the long-term sequelae of vasectomy, we investigated the early immune response in vasectomized mice. Vasectomy leads to rapid epithelial cell apoptosis and necrosis, persistent inflammation, and sperm granuloma formation in the epididymis. Vasectomized B6AF1 mice did not mount autoimmune response but instead developed sperm antigen-specific tolerance, documented as resistance to immunization-induced experimental autoimmune orchitis (EAO) but not experimental autoimmune encephalomyelitis. Strikingly, tolerance switches over to pathologic autoimmune state following concomitant CD4(+)CD25(+)Foxp3(+) regulatory T cell (Treg) depletion: unilaterally vasectomized mice produce dominant autoantibodies to an orchitogenic antigen (zonadhesin), and develop CD4 T-cell- and antibody-dependent bilateral autoimmune orchitis. Therefore, (i) Treg normally prevents spontaneous organ-specific autoimmunity induction by persistent endogenous danger signal, and (ii) autoantigenic stimulation with sterile autoinflammation can lead to tolerance. Finally, postvasectomy tolerance occurs in B6AF1, C57BL/6, and A/J strains. However, C57BL/6 mice resisted EAO after 60% Treg depletion, but developed EAO after 97% Treg reduction. Therefore, variance in intrinsic Treg function--a possible genetic trait--can influence the divergent tolerogenic versus autoimmune response to vasectomy.
Topics: Animals; Autoantibodies; Autoimmunity; Blotting, Western; Cell Proliferation; Electrophoresis, Polyacrylamide Gel; Immune Tolerance; Male; Membrane Proteins; Mice; Mice, Mutant Strains; Spermatozoa; Statistics, Nonparametric; T-Lymphocytes, Regulatory; Vasectomy
PubMed: 21502500
DOI: 10.1073/pnas.1017615108 -
The Canadian Veterinary Journal = La... Oct 2010An 8-month-old Yorkshire boar was presented for apparent azoospermia. Two semen collections also revealed azoospermia. Ultrasonographic examination of the gonads...
An 8-month-old Yorkshire boar was presented for apparent azoospermia. Two semen collections also revealed azoospermia. Ultrasonographic examination of the gonads revealed bilateral caput epididymal dilatation and anechoic fluid within the tubules. Because a testicular biopsy revealed normal spermatogenesis, an outflow tract obstruction was suspected. Multiple sperm granulomas were found within the parenchyma of both testes at necropsy.
Topics: Animals; Azoospermia; Epididymis; Fatal Outcome; Granuloma; Male; Prognosis; Swine; Testicular Diseases
PubMed: 21197205
DOI: No ID Found -
Molecular Reproduction and Development Jun 2010SED1/MFG-E8, herein referred to as SED1, is a bimotif adhesive protein with ascribed functions in a range of cell-cell interactions, including sperm-egg binding. In the...
SED1/MFG-E8, herein referred to as SED1, is a bimotif adhesive protein with ascribed functions in a range of cell-cell interactions, including sperm-egg binding. In the male reproductive tract, SED1 is secreted by the initial segment of the epididymis, where it coats sperm and subsequently facilitates binding to the egg zona pellucida. We have recently reported that SED1-null epididymides show an unexpected incidence of spermatic granulomas, reflecting breakdown of the epithelium and a consequent autoimmune response against sperm antigens. However, spermatic granulomas are most often manifest in the distal segments of the epididymis, whereas the bulk of SED1 is expressed in the proximal epididymis. In some models, the presence of granulomas in the distal epididymis is associated with an underlying defect in the maintenance of luminal fluid homeostasis. Herein, we report that SED1-null epididymal fluid is both hypo-osmotic and alkaline, relative to wildtype epididymal fluid. Furthermore, the SED1-null epididymal epithelium exhibits various hallmarks of disrupted fluid reabsorption and pH regulation, including altered morphology of clear cells, increased intracellular vesicles, and apical distribution of VATPase. Results indicate that the SED1-null epididymal pathologies are not the secondary consequences of defective testes or efferent ducts or of improper epididymal differentiation, unlike that seen in other epididymal models. The expression and distribution of various ion exchangers, channels, and enzymes that mediate fluid transport and pH regulation are examined in wildtype and SED1-null epididymides, and models to account for how SED1 functions in luminal fluid dynamics are discussed.
Topics: Animals; Body Fluids; Epididymis; Epithelial Cells; Hydrogen-Ion Concentration; Male; Membrane Proteins; Mice; Mice, Knockout; Osmolar Concentration
PubMed: 20422713
DOI: 10.1002/mrd.21189 -
Journal of Cell Science Mar 2009The epididymis is a highly convoluted tubule that connects the testis with the vas deferens, and in which mammalian sperm acquire the ability to fertilize eggs. The most...
The epididymis is a highly convoluted tubule that connects the testis with the vas deferens, and in which mammalian sperm acquire the ability to fertilize eggs. The most proximal portion of the epididymis, or initial segment, secretes numerous factors that are critical for sperm maturation and storage. One such factor is SED1 (also known as MFG-E8) a bi-motif protein composed of two N-terminal EGF domains, the second of which contains an RGD motif, and two C-terminal discoidin domains (also known as F5/8 type C domains). Previous studies have reported that SED1 is secreted into the epididymal lumen, where it coats sperm and later facilitates sperm-egg binding. Herein, we report that SED1-null males also harbor unexpected epididymal pathologies, including detached epithelia and spermatic granulomas. We therefore examined whether SED1 has a tissue-intrinsic role in the epididymis, in addition to its role in sperm-egg adhesion. Improved fixation protocols revealed that SED1 is found in the basolateral domains of epididymal epithelial cells in vivo, and similarly, SED1 is secreted both apically and basally from polarized epididymal cells in vitro. The basolateral distribution of SED1 suggests that it may play a novel role in epididymal cell adhesion. Consistent with this, in vitro assays showed that SED1 supports epididymal cell adhesion via RGD binding to alphaV integrin receptors on epididymal epithelial cells. Finally, epididymal cells from SED1-null males showed reduced adhesion in vitro, a phenotype that can be rescued with exogenous SED1. These results suggest that SED1 facilitates epididymal cell adhesion, and that its loss leads to breakdown of the epididymal epithelium and consequent development of spermatic granulomas.
Topics: Animals; Antibodies, Blocking; Cell Adhesion; Cell Polarity; Epididymis; Epithelial Cells; Granuloma; Integrin alphaV; Integrin beta Chains; Male; Membrane Proteins; Mice; Models, Biological; Oligopeptides; Protein Subunits; Recombinant Proteins; Seminiferous Tubules; Spermatic Cord
PubMed: 19240116
DOI: 10.1242/jcs.041731 -
Canadian Urological Association Journal... Nov 2007Advances in surgical techniques have improved the outcome of microsurgical vasovasostomy (VV). We performed a retrospective analysis of surgical procedures to determine...
OBJECTIVES
Advances in surgical techniques have improved the outcome of microsurgical vasovasostomy (VV). We performed a retrospective analysis of surgical procedures to determine outcomes and predictors of VV success, to develop Kaplan-Meier Curves for predicting VV outcomes and to evaluate the use of alpha-glucosidase (AG) to predict outcomes.
PATIENTS AND METHODS
We undertook a retrospective analysis of 747 modified 1-layer microsurgical VV procedures performed between 1984 and 2000. Obstructive interval, partner status, social status preoperatively and method of vasal obstruction, vasal fluid quality and sperm granuloma intraoperatively were compared with outcome results. Parameters evaluated at follow-up included semen analysis, AG concentration in ejaculate fluid and pregnancy rates.
RESULTS
The overall patency rate was 86% and pregnancy rates were 33% and 53% at 1 and 2 years after primary VV, respectively. Preoperative factors associated with successful outcome and pregnancy included shorter obstructive interval and same female partner (p < 0.05). Intraoperative factors predicting success included the use of surgical clips instead of suture at vasectomy, the presence of a sperm granuloma, the presence and quality of vasal fluid, and the presence and quality of sperm in vasal fluid. Further, increased AG in the postoperative semen predicted improved patency and pregnancy outcomes.
CONCLUSION
This study confirms the effectiveness of VV for vasectomized men who wish to father children. It also demonstrates that preoperative and intraoperative factors are predictive of the VV outcome. Postoperative AG is also a useful marker of patency and it appears to predict pregnancy outcome.
PubMed: 18542824
DOI: 10.5489/cuaj.454 -
Journal of Anatomy Aug 2004Using stereological methods, especially the optical disector for unbiased estimation of nuclear number, our recent study demonstrated that long-term (6 or 12 months)...
Using stereological methods, especially the optical disector for unbiased estimation of nuclear number, our recent study demonstrated that long-term (6 or 12 months) vasectomy in the rhesus monkey had no significant effects on spermatogenesis (Peng et al. Reproduction 2002, 124, 847-856). This study aimed to determine the scenario in the rabbit using the same morphometric methodology. Three groups of normal male Japanese white rabbits (aged 4-5 months) were subjected to unilateral vasectomy; 10 days, 6 months and 12 months later both testes and epididymides were removed. Testicular and epididymal methacrylate-embedded sections were obtained for stereology. Vasectomy-induced damage to spermatogenesis was observed, primarily sloughing of spermatogenic cells with a greater reduction in the number of advanced (adluminal) cells. The damage was most severe at 10 days, occurring in all the testes on the vasectomized side and involving sloughing of even type A spermatogonia, the number of which returned to normal at 6 and 12 months. Damage was less severe at 6 and 12 months, being found in half of the testes of the vasectomy side, in which the total numbers of later germ cell types were 24.0-59.1% (spermatocytes) and 0.3-11.6% (spermatids) of control at 6 months, and 20.1-22.1% (spermatocytes) and 0.4-12.0% (spermatids) of control at 12 months. By contrast, Sertoli cell number per testis was unchanged following vasectomy in any group. Epididymis on the vasectomy side, especially at 10 days and 6 months, appeared larger than on the contralateral side, but this difference was not statistically significant, and no sperm granuloma was seen in the epididymis.
Topics: Animals; Cell Count; Epididymis; Male; Rabbits; Seminiferous Tubules; Spermatocytes; Spermatogenesis; Spermatozoa; Testis; Time Factors; Vasectomy
PubMed: 15291797
DOI: 10.1111/j.0021-8782.2004.00322.x -
Annals of Surgery Aug 2004To evaluate the impact of bench model fidelity on the acquisition of technical skill using clinically relevant outcome measures. (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
OBJECTIVE
To evaluate the impact of bench model fidelity on the acquisition of technical skill using clinically relevant outcome measures.
METHODS
Fifty junior surgery residents participated in a 1-day microsurgical training course. Participants were randomized to 1 of 3 groups: 1) high-fidelity model training (live rat vas deferens; n = 21); 2) low-fidelity model training (silicone tubing; n = 19); or 3) didactic training alone (n = 10). Following training, all participants were assessed on the high- and low-fidelity bench models. Immediate outcome measures included procedure times, blinded, expert assessment of videotaped performance using checklists and global rating scales, anastomotic patency, suture placement precision, and final product ratings. Delayed outcome measures (obtained from the live rat vas deferens 30 days following training) included anastomotic patency, presence of a sperm granuloma, and the presence of sperm on microscopy.
RESULTS
Following training, checklist (P < 0.001) and global rating scores (P < 0.001) on the bench model simulators were higher among subjects who received hands-on training, irrespective of model fidelity. Immediate anastomotic patency rates of the rat vas deferens were higher with increasing model fidelity training (P = 0.048). Delayed anastomotic patency rates were higher among subjects who received bench model training, irrespective of model fidelity (P = 0.02). Rates of sperm presence on microscopy were higher among subjects who received high-fidelity model training compared with subjects who received didactic training (P = 0.039) but did not differ among subjects in the high- and low-fidelity groups.
CONCLUSIONS
Surgical skills training on low-fidelity bench models appears to be as effective as high-fidelity model training for the acquisition of technical skill among novice surgeons.
Topics: Adult; Animals; Clinical Competence; Education, Medical, Graduate; Educational Measurement; Female; Humans; Inservice Training; Internship and Residency; Male; Microsurgery; Models, Animal; Rats; Sensitivity and Specificity
PubMed: 15273564
DOI: 10.1097/01.sla.0000133346.07434.30 -
Journal of Andrology 2003Testicular biopsies from 80 azoospermic young men were revised and the average numbers per cross-sectioned tubule of each germ cell type were calculated and compared...
Testicular biopsies from 80 azoospermic young men were revised and the average numbers per cross-sectioned tubule of each germ cell type were calculated and compared with those of control normal testes. In 53 patients, azoospermia had an obstructive cause, and in 22 of those 53 patients more adult spermatids were found by testicular biopsy than young spermatids (over 100% in some testes), in one or both testes. However, in normal testes fewer mature spermatids than young spermatids (23.3%) were found. In the 22 patients, the causes of azoospermia were: vasectomy (7 patients), bilateral agenesis of the vas deferens (3 patients), Young syndrome (3 patients), bilateral cysts in the caput epididymidis (1 patient), bilateral inguinal herniorrhaphy (1 patient), left varicocele (1 patient), and unknown causes (6 patients). Biopsies were bilateral except for 3 cases (a vasectomized patient, a patient with Young syndrome, and a patient with obstruction due to an unknown cause). Hormonal levels were normal in the 22 patients. In addition, testicular biopsies of 3 twisted testes from 3 young adult men showing a number of adult spermatids higher than that of young spermatids were also included in the study. All testicular biopsies-including those of the twisted testes-showed an obstructive histologic pattern, consisting of a mosaic distribution of testicular lesions: mainly tubular ectasis and germ cell sloughing into the adluminal compartment of seminiferous tubules. The increase in the number of adult spermatids was bilateral in 1 of the 6 vasectomized men who underwent bilateral biopsy, and in 7 of the 11 bilaterally biopsied patients with obstructive azoospermia due to other causes. The most probable explanation for the increased number of adult spermatids is stagnation of testicular fluid, caused by sperm excretory duct obstruction. The unilateral increase in the number of adult spermatids in vasectomized men might be related to the occurrence of a spermatic granuloma (a frequent finding in vasectomy) in the proximal end of the sectioned ductus deferens ipsilateral to the testis with nonincreased adult spermatid numbers, and the absence of spermatic granuloma in the ductus deferens ipsilateral to the testis with increased adult spermatid numbers. This granuloma would produce, in addition to spermatozoon destruction, reabsorption of the testicular and epididymal fluids. The higher rate of bilateral increase, in the number of young spermatids observed in the patients with congenital lesions of the ductus deferens or the ductus epididymidis, might be related to the absence of spermatic granulomas in congenital obstructions.
Topics: Adult; Biopsy; Humans; Male; Middle Aged; Oligospermia; Sperm Count; Spermatids; Spermatogonia; Testis; Vasectomy
PubMed: 12954664
DOI: 10.1002/j.1939-4640.2003.tb02733.x