Vasectomy re-reversal: effectiveness and parameters associated with its success

ABSTRACT Introduction: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. Purpose: To determine the VRR effectiveness and whether specific parameters can be associated with its success. Materials and Methods: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). Results: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). Conclusions: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.

Vasectomy re-reversal: effectiveness and parameters associated with its success.

INTRODUCTION: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. PURPOSE: To determine the VRR effectiveness and whether specific parameters can be associated with its success. MATERIALS AND METHODS: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). RESULTS: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). CONCLUSIONS: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.

Stereological analysis of elastic fibers of the corpus cavernosum of rats during the aging process.

PURPOSE: To evaluate changes in the quantity of elastic fibers in the corpora cavernosa of rats during the natural aging process, and to assess the degree of this change by determining volumetric density (Vv) at different ages via stereological analysis. METHODS: Forty-eight rats, raised under similar conditions, were subjected to the natural aging process and divided into four groups (G1 to G4), according to age at the time of penectomy (6, 9, 12, and 24 months, respectively). Histological sections of the middle segment of the penis were stained with Weigert's resorcin-fuchsin, and the volumetric density (Vv) of elastic fibers of the corpora cavernosa were determined via stereological analysis. RESULTS: There were no statistically significant differences in Vv among groups G1, G2, and G3. These three groups were therefore considered as a single group. The mean Vv of this group showed a statistically significant reduction compared to that of G4 (0.16 vs. 0.11, p<0.05). CONCLUSION: Natural aging in rats was responsible for a reduction in volumetric density of elastic fibers of the corpora cavernosa (approximately 30% decrease in Vv) during senescence.

Stereological analysis of elastic fibers of the corpus cavernosum of rats during the aging process

Abstract Purpose To evaluate changes in the quantity of elastic fibers in the corpora cavernosa of rats during the natural aging process, and to assess the degree of this change by determining volumetric density (Vv) at different ages via stereological analysis. Methods Forty-eight rats, raised under similar conditions, were subjected to the natural aging process and divided into four groups (G1 to G4), according to age at the time of penectomy (6, 9, 12, and 24 months, respectively). Histological sections of the middle segment of the penis were stained with Weigert's resorcin-fuchsin, and the volumetric density (Vv) of elastic fibers of the corpora cavernosa were determined via stereological analysis. Results There were no statistically significant differences in Vv among groups G1, G2, and G3. These three groups were therefore considered as a single group. The mean Vv of this group showed a statistically significant reduction compared to that of G4 (0.16 vs. 0.11, p<0.05). Conclusion Natural aging in rats was responsible for a reduction in volumetric density of elastic fibers of the corpora cavernosa (approximately 30% decrease in Vv) during senescence.

Stereological and morphological analysis of the effects of aging on spermatogenesis in rat testis 1.

PURPOSE: To quantify, through stereological and morphometric analysis, spermatogenesis in rats undergoing the natural aging process. METHODS: Seventy-two male Wistar rats were divided into 6 equal groups according to age at the time of killing: 3, 6, 9, 12, 18, and 24 months. All the rats were subjected orchiectomy and collection of testicular parenchymal fragments for histological and morphometric analysis. The numerical density of spermatids was calculated using a stereological study, and morphometric analysis was conducted to measure the height of the germinal epithelium and the area of the seminiferous tubules. RESULTS: We found that the 18 and 24 months groups showed a significant reduction in the number of round spermatids. However, the height of the germinal epithelium was not significantly different between the groups. The area of seminiferous tubules was also significantly reduced in the elderly rats compared to that in the young ones. CONCLUSION: Aging of rats showed a significant reduction in the number of round spermatids and the area of the seminiferous tubules, more pronounced in the rats at 18 and 24 months of life.

Stereological and morphological analysis of the effects of aging on spermatogenesis in rat testis

Abstract Purpose: To quantify, through stereological and morphometric analysis, spermatogenesis in rats undergoing the natural aging process. Methods: Seventy-two male Wistar rats were divided into 6 equal groups according to age at the time of killing: 3, 6, 9, 12, 18, and 24 months. All the rats were subjected orchiectomy and collection of testicular parenchymal fragments for histological and morphometric analysis. The numerical density of spermatids was calculated using a stereological study, and morphometric analysis was conducted to measure the height of the germinal epithelium and the area of the seminiferous tubules. Results: We found that the 18 and 24 months groups showed a significant reduction in the number of round spermatids. However, the height of the germinal epithelium was not significantly different between the groups. The area of seminiferous tubules was also significantly reduced in the elderly rats compared to that in the young ones. Conclusion: Aging of rats showed a significant reduction in the number of round spermatids and the area of the seminiferous tubules, more pronounced in the rats at 18 and 24 months of life.

Spermatozoa retrieval for cryopreservation after death

ABSTRACT Objectives To describe the retrieval spermatozoa technique for cryopreservation after death, including the proximal part of vas deferens. Material and Methods A 28-years old man, with previous history of infertility, who had died 12 hours before, was submitted to spermatozoa retrieval for cryopreservation, with surgical bilateral resection in bloc of the proximal part of vas deferens, testicle and epididymis. At the laboratory, by milking the epididymis and vas deferens, the extracted fluid was collected; also, three samples of each testicle parenchyma were also harvested. Results The fluid from the vas deferens showed spermatozoa, mostly with in situ motility. Testicular fragments also presented spermatozoa, mostly with small tail movements or immobile. Conclusion The inclusion of the proximal part of vas deferens during spermatozoa retrieval after death must be performed, since it contains high concentration of spermatozoa, and even in the presence of previous infertility, as was with this patient, it is possible to retrieve spermatozoa.

Spermatozoa retrieval for cryopreservation after death.

OBJECTIVES: To describe the retrieval spermatozoa technique for cryopreservation after death, including the proximal part of vas deferens. MATERIAL AND METHODS: A 28-years old man, with previous history of infertility, who died 12 hours ago, was submitted to spermatozoa retrieval for cryopreservation, with surgical bilateral resection in bloc of the proximal part of vas deferens, testicle and epididymis. At the laboratory, by milking the epididymis and vas deferens, the extracted fluid was collected; also, three samples of each testicle parenchyma were also harvested. RESULTS: The fluid from the vas deferens showed spermatozoa, mostly with in situ motility. Testicular fragments also presented spermatozoa, mostly with small tail movements or immobile. CONCLUSION: The inclusion of the proximal part of vas deferens during spermatozoa retrieval after death must be performed, since it contains high concentration of spermatozoa, and even in the presence of previous infertility, as was with this patient, it is possible to retrieve spermatozoa.

Numeric and volumetric changes in Leydig cells during aging of rats.

PURPOSE: To analyze the effects of aging in rats on the nuclear volume, cytoplasmic volume, and total volume of Leydig cells, as well as their number. METHODS: Seventy-two Wistar rats were divided into six subgroups of 12 rats, which underwent right orchiectomy at 3, 6, 9, 12, 18, and 24 months of age. The weight and volume of the resected testicles were assessed. A stereological study of Leydig cells was conducted, which included measurements of cell number and nuclear, cytoplasmic, and total cell volumes. RESULTS: The weight and volume of the resected testicles showed reductions with age. Only the subgroup composed of 24-month old rats showed a decrease in the nuclear volume of Leydig cells. Significant reductions in the cytoplasmic volume and total volume of Leydig cells were observed in 18- and 24-month old rats. The number of Leydig cells did not vary significantly with age. CONCLUSIONS: Aging in rats resulted in reduction of the nuclear, cytoplasmic, and total cell volumes of Leydig cells. There was no change in the total number of these cells during aging.

Numeric and volumetric changes in Leydig cells during aging of rats

Abstract Purpose: To analyze the effects of aging in rats on the nuclear volume, cytoplasmic volume, and total volume of Leydig cells, as well as their number. Methods: Seventy-two Wistar rats were divided into six subgroups of 12 rats, which underwent right orchiectomy at 3, 6, 9, 12, 18, and 24 months of age. The weight and volume of the resected testicles were assessed. A stereological study of Leydig cells was conducted, which included measurements of cell number and nuclear, cytoplasmic, and total cell volumes. Results: The weight and volume of the resected testicles showed reductions with age. Only the subgroup composed of 24-month old rats showed a decrease in the nuclear volume of Leydig cells. Significant reductions in the cytoplasmic volume and total volume of Leydig cells were observed in 18- and 24-month old rats. The number of Leydig cells did not vary significantly with age. Conclusions: Aging in rats resulted in reduction of the nuclear, cytoplasmic, and total cell volumes of Leydig cells. There was no change in the total number of these cells during aging.

Sperm analysis of the vas deferens fluid after a long interval of unilateral percutaneous epididymal sperm aspiration in vasectomized patients.

OBJECTIVES: Evaluation of the presence of spermatozoa in vas deferens fluid after a long interval of unilateral and homolateral percutaneous epididymal sperm aspiration (PESA) in vasectomized men. When found, the spermatozoa were evaluated including concentration and motility, in order to verify the patency of the epididymal tubules. MATERIALS AND METHODS: Four patients, numbered in a progressive order, from one to four, with 38, 40, 48 and 51 years old and vasectomy interval of 10, 10, 25 and 11 years, respectively, whose wives did not get pregnant using intracytoplasmic sperm injection of sperm obtained by unilateral PESA and decided to try only natural conception, were submitted to intrasurgical sperm analysis of the vas deferens fluid (ISAVDF) during microsurgery for reconstruction of the seminal tract. RESULTS: Time interval between PESA and ISAVDF was 13.75 ± 11.12 months (x ± s) varying from 3 to 29 months. Homolateral ISAVDF and PESA showed the presence of spermatozoa. Patients 1, 2 and 4 had a high concentration of 10 x 106, 64 x 106 and 45 x 106 spermatozoa/ mL; the first two had motile sperms and patient 3 had no sperms. CONCLUSIONS: Three of four patients showed spermatozoa in the vas deferens fluid after a long interval of unilateral and homolateral PESA with high concentration, including motile forms. These findings support the concept that PESA may not result in late epipidymal tubule obstruction in vasectomized patients.

Sperm analysis of the vas deferens fluid after a long interval of unilateral percutaneous epididymal sperm aspiration in vasectomized patients

Objectives Evaluation of the presence of spermatozoa in vas deferens fluid after a long interval of unilateral and homolateral percutaneous epididymal sperm aspiration (PESA) in vasectomized men. When found, the spermatozoa were evaluated including concentration and motility, in order to verify the patency of the epididymal tubules. Materials and Methods Four patients, numbered in a progressive order, from one to four, with 38, 40, 48 and 51 years old and vasectomy interval of 10, 10, 25 and 11 years, respectively, whose wives did not get pregnant using intracytoplasmic sperm injection of sperm obtained by unilateral PESA and decided to try only natural conception, were submitted to intrasurgical sperm analysis of the vas deferens fluid (ISAVDF) during microsurgery for reconstruction of the seminal tract. Results Time interval between PESA and ISAVDF was 13.75 ± 11.12 months (x ± s) varying from 3 to 29 months. Homolateral ISAVDF and PESA showed the presence of spermatozoa. Patients 1, 2 and 4 had a high concentration of 10 x 106, 64 x 106 and 45 x 106 spermatozoa/ mL; the first two had motile sperms and patient 3 had no sperms. Conclusions Three of four patients showed spermatozoa in the vas deferens fluid after a long interval of unilateral and homolateral PESA with high concentration, including motile forms. These findings support the concept that PESA may not result in late epipidymal tubule obstruction in vasectomized patients. .

Long-term effects of the testicular torsion on the spermatogenesis of the contralateral testis and the preventive value of the twisted testis orchiepididymectomy.

PURPOSE: To determine whether the testicular torsion causes long-term effects on the spermatogenesis of the contralateral testis, and whether the orchiepididymectomy of the twisted testis could prevent them, using specific spermatogenesis parameters to elucidate the conflicting results in the literature. METHODS: Seventy-four pubertal male Wistar rats were randomly selected. The experimental group consisted of 40 rats, divided into four subgroups, submitted to 1.080 degrees counterclockwise left testicular torsion and its scrotal fixation at the beginning of the experiment, and left orchiepididymectomy at one, five, ten and 90 days, respectively. The control group consisted of 24 rats, divided into four sham operation control subgroups. An additional control subgroup consisted of the ten remaining rats, submitted only to the left orchiepididymectomy at the beginning. At 90 days, the contralateral testes of the experimental and control subgroups were collected for the evaluation of their spermatogenesis parameters: testicular weight, seminiferous tubular diameter, Johnsen score and differential counting of the germ cells. RESULTS: No statistically significant differences were observed among the experimental and control subgroups for all of the spermatogenesis parameters of the contralateral testes. CONCLUSIONS: Testicular torsion does not cause long-term effects on the spermatogenesis of the contralateral testis in pubertal rats, and the orchiepididymectomy of the twisted testis is not necessary for preventive purposes for the contralateral spermatogenesis.

Long-term effects of the testicular torsion on the spermatogenesis of the contralateral testis and the preventive value of the twisted testis orchiepididymectomy / Efeitos tardios da torção testicular sobre a espermatogênese do testículo contralateral e o valor preventivo da orquiepididimectomia do testículo torcido

PURPOSE: To determine whether the testicular torsion causes long-term effects on the spermatogenesis of the contralateral testis, and whether the orchiepididymectomy of the twisted testis could prevent them, using specific spermatogenesis parameters to elucidate the conflicting results in the literature. METHODS: Seventy-four pubertal male Wistar rats were randomly selected. The experimental group consisted of 40 rats, divided into four subgroups, submitted to 1.080 degrees counterclockwise left testicular torsion and its scrotal fixation at the beginning of the experiment, and left orchiepididymectomy at one, five, ten and 90 days, respectively. The control group consisted of 24 rats, divided into four sham operation control subgroups. An additional control subgroup consisted of the ten remaining rats, submitted only to the left orchiepididymectomy at the beginning. At 90 days, the contralateral testes of the experimental and control subgroups were collected for the evaluation of their spermatogenesis parameters: testicular weight, seminiferous tubular diameter, Johnsen score and differential counting of the germ cells. RESULTS: No statistically significant differences were observed among the experimental and control subgroups for all of the spermatogenesis parameters of the contralateral testes. CONCLUSIONS: Testicular torsion does not cause long-term effects on the spermatogenesis of the contralateral testis in pubertal rats, and the orchiepididymectomy of the twisted testis is not necessary for preventive purposes for the contralateral spermatogenesis.

OBJETIVO: Determinar se a torção testicular causa efeitos tardios sobre a espermatogênese do testículo contralateral e se a orquiepididimectomia do testículo torcido poderia preveni-los, usando parâmetros específicos da espermatogênese para elucidar os resultados conflitantes na literatura. MÉTODOS: Foram selecionados aleatoriamente 74 ratos machos púberes da linhagem Wistar. O grupo experimental foi composto por 40 ratos divididos em quatro subgrupos, submetidos à torção anti-horária de 1,080 graus do testículo esquerdo e sua fixação escrotal no início do experimento e à orquiepidimectomia esquerda com um, cinco, dez e 90 dias, respectivamente. O grupo controle foi composto por 24 ratos divididos em quatro subgrupos de cirurgias simuladas. Um subgrupo controle adicional foi constituído pelos dez ratos restantes submetidos unicamente à orquiepididimectomia esquerda no início do experimento. Aos 90 dias, os testículos contralaterais dos subgrupos experimentais e controles foram coletados para avaliação dos parâmetros de suas espermatogêneses: peso testicular, diâmetro do túbulo seminífero, graduação de Johnsen e contagem diferencial das células germinativas. RESULTADOS: Não houve diferença estatisticamente significativa entre todos os subgrupos experimentais e controles para todos os parâmetros analisados da espermatogênese dos testículos contralaterais. CONCLUSÕES: A torção testicular não causa efeitos tardios sobre a espermatogênese do testículo contralateral em ratos púberes e a orquiepididimectomia do testículo torcido não é necessária para fins preventivos da espermatogênese contralateral.

Ipsilateral testicular necrosis and atrophy after 1,080-degree torsion of the spermatic cord in rats.

PURPOSE: To assess the incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord, and 60 days after detorsion of the spermatic cord. METHODS: 42 rats were divided in 7 groups. Except for the control group, surgical torsion of the right spermatic cord was performed in all groups (T0). After 1, 2, or 4 hours of torsion, each group underwent either ipsilateral orchiectomy (groups OT1, OT2, and OT4), or detorsion of the spermatic cord and observation for 60 days (groups DT1, DT2, and DT4), before they were evaluated for the presence of testicular necrosis/atrophy. RESULTS: Only one rat (5.5%) in groups OT1, OT2, and OT4 had testicular necrosis, in comparison with six rats (33.3%) in groups DT1, DT2, and DT4 (p=0.04). The incidence of testicular necrosis/atrophy was not different between subgroups T1, T2, and T4, and the control group (p>0.05). There was, however, a tendency toward greater incidence of necrosis/atrophy in the rats in group DT4. CONCLUSION: The incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord is 5.5%, in comparison with 33.3% sixty days after detorsion of the spermatic cord.

Ipsilateral testicular necrosis and atrophy after 1.080-degree torsion of the spermatic cord in rats / Necrose e atrofia do testículo ipsilateral após torção de 1080 graus do cordão espermático em ratos

PURPOSE: To assess the incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord, and 60 days after detorsion of the spermatic cord. METHODS: 42 rats were divided in 7 groups. Except for the control group, surgical torsion of the right spermatic cord was performed in all groups (T0). After 1, 2, or 4 hours of torsion, each group underwent either ipsilateral orchiectomy (groups OT1, OT2, and OT4), or detorsion of the spermatic cord and observation for 60 days (groups DT1, DT2, and DT4), before they were evaluated for the presence of testicular necrosis/atrophy. RESULTS: Only one rat (5.5%) in groups OT1, OT2, and OT4 had testicular necrosis, in comparison with six rats (33.3%) in groups DT1, DT2, and DT4 (p=0.04). The incidence of testicular necrosis/atrophy was not different between subgroups T1, T2, and T4, and the control group (p>0.05). There was, however, a tendency toward greater incidence of necrosis/atrophy in the rats in group DT4. CONCLUSION: The incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord is 5.5%, in comparison with 33.3% sixty days after detorsion of the spermatic cord.

OBJETIVO: Avaliar a incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático e 60 dias após a destorção do cordão espermático. MÉTODOS: 42 ratos foram separados em 7 grupos. Exceto para o grupo controle, todos os animais foram submetidos à torção operatória do cordão espermático direito (T0). Após 1, 2 ou 4 horas de torção, cada grupo foi submetido a orquiectomia ipsilateral (grupos OT1, OT2 e OT4), ou destorção do cordão espermático e observação por 60 dias (grupos DT1, DT2 e DT4), antes de serem avaliados para a presença de necrose/atrofia testicular. RESULTADOS: Somente um rato (5,5 por cento) nos grupos OT1, OT2 e OT4 apresentou necrose testicular em comparação com 6 ratos (33,3%) nos grupos DT1, DT2 e DT4 (p=0,04). A incidência de necrose/atrofia testicular não foi diferente entre os subgrupos T1, T2 e T4 e o grupo controle (p>0,05). Houve, no entanto, uma tendência a maior incidência de necrose/atrofia nos ratos do grupo DT4. CONCLUSÃO: A incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático é de 5,5% em comparação com 33,3% sessenta dias após a destorção do cordão espermático.