高频超声在输精管结扎术后附睾淤积症中的临床应用

目的:探讨高频超声在输精管结扎术后附睾淤积症诊治中的临床应用。方法:回顾性分析2002～2010年23例确诊为输精管结扎术后附睾淤积症患者的声像图特点,按照淤积附睾内部回声分为轻度淤积5例、中度淤积11例、重度淤积7例,观察其在临床治疗中的意义。结果:23例患者中14例显示双侧附睾体积增大,6例显示左侧附睾增粗,3例显示右侧附睾增粗,以体、尾增大为主;经过保守治疗,其中5例轻度淤积、11例中度淤积和2例重度淤积患者好转后出院,另外5例重度淤积患者保守治疗后联合输精管复通术症状明显减轻后出院。结论:输精管结扎术后附睾淤积症具有典型的声像图特征,高频超声对其临床分型、诊断和治疗有极为重要的应用价值。     

247例附睾郁积症的治疗并长期随访观察

附睾郁积症是输精管结扎术后的常见并发症之一。我们于1985年在湖北省长阳土家族自治县对14414例接受输精管结扎术者进行了术后并发症调查,其中患附睾郁积症247例,均根据具体情况采用不同的治疗方法。近10年来,我们对247例附睾郁积症患者进行了追踪观察,现将其追踪观察结果报告如下。1　临床资料247例根据临床症状分为轻、中、重度附睾郁积症,其中轻度61例,常年感阴囊、睾丸轻度坠胀不适,不影响工作和生活(包括性生活);检查见附睾有轻度肿大和触痛,近睾端输精管增粗。中度163例,除上述症状外,还伴有下腰部胀痛,部分患者伴有发作性加重,发作…     

恒河猴两种节育术后睾丸附睾的组织学及超微结构观察

本文介绍了12只恒河猴输精管结扎术及输精管内过滤装置节育术术后睾丸、附睾和输精管的组织学及超微结构观察结果。术后两年内,两组动物睾丸的组织学及超微结构均无异常改变。术后9月,结扎猴的尾部附睾管及近睾端输精管管腔显著扩张、上皮变薄、腔内充满大量变性、坏死精子,出现附睾郁积。附睾主细胞出现微绒毛疏短、排列紊乱等超微结构变化;而行过滤装置节育的动物附睾管及输精管的组织学及超微结构均未见异常改变。提示两种节育术对睾丸形态结构均无影响;但输精管结扎木可导致附睾郁积及其上皮的萎缩性变化,而过滤装置节育术后无此改变,值得进一步探讨。     

先天性输精管一侧缺如22例

自 1 98 9年 1月至 1 999年 1月 ,我们共做输精管结扎术 2 1 986例 ,其中发现输精管一侧缺如 2 2例 ,现报告如下。一、临床资料1 .一般资料 :本组 2 2例中 ,年龄 2 6～ 3 0岁 7例 ,3 1～ 40岁 1 4例 ,>40岁 1例。左侧输精管缺如 2 1例 ,右侧输精管缺如 1例。2 .节育手术方法及术后随访 :2 2例均采用直视钳穿法结扎另一侧输精管 ,术后随访观察1～ 1 1年 ,除 1例发生轻度附睾淤积症外 ,其余均无术后并发症发生。每例受术者分别于术后半年和 1年各做精液化验 1次 ,精子计数均为零。术后无女方再孕 ,节育效果可靠二、讨论先天性输精管一侧缺如 ,…     

输精管内滤过装置术后血精5例临床分析

目的探讨输精管内滤过装置(IVD)术后出现血精的原因及处理对策。方法对5例行IVD置入术后出现血精的患者进行检查和治疗:(1)阴囊检查3例。1例有附睾淤积症状者行单侧输精管IVD取出并输精管复通术,1例痛性结节症状者行双侧输精管结节切除并输精管复通术,1例行单侧输精管复通术。(2)行精囊镜检查1例。(3)给予抗炎止血等保守治疗1例。所有病例确定时间进行随访。结果3例复通术中2例在术后1个月至1年精液检查发现精子,1例复通后1个月精液复查发现少量精子,但其后多次复查精子消失,考虑吻合口堵塞。1例精囊镜检查术中双侧精囊内均未找到IVD。所有病例随访半年以上血精仍没有消失。结论 IVD术后长期的血精应该引起必要的重视,血精症状的反复发作及迁延不愈往往给患者造成巨大的心理压力。输精管节育术后应加强定期随访,及时发现身体异常情况,及时处理,减少IVD严重并发症发生,建议对于放置IVD的年限以及在取出IVD前定期随访都应有严格明确的规定。     

三种方法治疗附睾郁积症疗效观察

自1983年8月至今，我们采用封闭疗法、输精管吻合术及附睾切除术，治疗附皋郁积症31例，现报告如下。1临床资料年龄26～47（平均31．5）岁；病程：1～19年；左侧24例，右侧7例；职业：干部1例，工人毛例，农民26例。结扎结节位于中段者22例，下段者7例，上段者2例（将输精管阴羹段按3等份分为上、中、下三段）。合井症：精索静脉曲张4例，附睾炎3例，精索粘连2例。2诊断标准格精管阻断术后半年以上，附睾持续均匀肿胀，表面光滑，加压有不适或疼痛。结节无压痛，近自端输精管稍粗大或正常。性生活后或劳累后局部不适或伴腰痛。3治疗方法与结…     

可逆性非阻塞性男性避孕法的研究概况

输精管结扎、堵塞术有许多优点,但由于输精管被阻断,使不断产生的精子、睾网液、附睾液必然滞留于输精管近睾端及附睾管中。导致不同程度的附睾郁积,个别还发生附睾郁积症。故研究非阻塞性的输精管节育方法已成为国内、外关注的课题。实验证明,结扎后的输精管近睾端及尾部附睾管有明显扩张,上皮变薄,附睾主细胞出现微绒毛疏短,排列紊乱等结构变化,管腔内郁滞大量变性     

活脉疏痛灵治疗输精管绝育术后附睾淤积症100例临床研究

我站1989年～1998年共行输精管绝育术14384例。经男科门诊复诊及随访,术后并发感染、血肿、附睾淤积、痛性结节等术后并发症共计316例,发生率为2.19％。其中附睾淤积症100例占并发症发生率的31.64％。占绝育总数的0.69％。     

输精管结扎术后近期附睾的超声表现

目的探讨输精管结扎术后近期对附睾大小的影响,获取术后近期附睾的影像学资料。方法选择60例自愿接受输精管结扎术的结扎对象,应用高频彩色多普勒超声于术前及术后1、2、3、6、12个月检查附睾及睾丸的大小。结果术后60例受术者双侧附睾均出现增厚,术后1个月与术前比较、术后2个月与术后1个月比较、术后3个月与术后2个月比较、术后6个月与术后3个月比较,差异均有统计学意义(P0.01);术后12个月与术后6个月比较,差异无统计学意义(P0.05)。结论术后6个月内附睾呈进行性增厚,之后附睾基本恢复分泌-吸收平衡;中轻度VC不会加重输精管结扎后近期附睾淤积的程度。     

"套叠式"输精管附睾吻合术治疗梗阻性无精子症

目的探讨“套叠式”输精管附睾吻合术治疗梗阻性无精子症的疗效。方法在放大镜辅助下，对45例OA行纵向两针“套叠式”输精管附睾吻合术（LIVES），3个月后每月分析精液1次，随访配偶受孕率。结果术中发现梗阻部位在附睾管或近睾段输精管，双侧吻合36例，单侧吻合9例，40例随访超过6个月，35例超过12个月；29例（72．5％）术后3．1—6．6个月从精液中检出精子，其中7例（20％）配偶受孕成功。结论高倍镜下纵向两针“套叠式”输精管附睾吻合术，能够严密而准确地对合管腔，有利于提高输精管道复通率和配偶受孕率。     

Morphological changes of spermatozoa in proximal vas deferens after vasectomy

AIM: To investigate the morphological changes of spermatozoa in the proximal vas deferens after vasectomy. METHODS: Proximal vas deferens fluids were collected from 79 fertile men (group A) and 64 vasectomized men (group B) during the operations of vasectomy or vasovasostomy. Sperm morphology in the proximal vas deferens was analyzed after staining with the modified Papanicolaou method. RESULTS: The percentage of spermatozoa with a normal oval head from group B (50. 7% +/- 21.7%) was significantly lower than that of group A (75.2% +/- 11.1%). The data in group A was similar to those of normal semen and therefore represents the physiological condition of the proximal vas deferens sperm of fertile men. There were no significant differences in the percentages of normal oval heads in group B with the time since vasectomy. CONCLUSION: After vasectomy, the spermatozoa in the proximal vas deferens and epididymis were continuously degenerating and being replenished by spermatozoa coming from testis. The obvious morphological degeneration occurred in the sperm tail and spermatozoa with a small oval head and amorphous heads were increased.     

Analysis of spermatozoa from the proximal vas deferens of vasectomized men

This study assessed the condition of spermatozoa from the proximal vas deferens of men after vasectomy. The fluids of both proximal vas deferens were collected from 67 vasectomized men by cannulating the vas deferens at the time of vasectomy reversal. Selected sperm parameters were analysed after incubation of the spermatozoa for 30 min at 37°C. Spera concentration in the proximal vas from vasectomized men (16 312 ± 21 496 million per ml, geometric mean: 7948 ± 398 million per ml) was significantly higher than that of fertile men and was maintained at a constant level independent of the duration of vas obstruction. The means of sperm motility (36.2 ± 26.2%), spermatozoa with normal morphology (50.7 ± 21.7%), sperm viability (53.0 ± 25.3%) and hypo-osmotic swelling test (HOS-test, 53.9 ± 21.7%) were statistically lower than the respective values for normal fertile men. There was no significant correlation between the duration of vas obstruction and the above semen parameters. In 46.4% of vas fluids all spermatozoa were immotile and this condition was more common after 3 years of vasectomy. Immotile spermatozoa in the proximal vas fluids at the time of vasectomy reversal may be an important factor for predicting semen quality and fertilizing ability after vasovasostomy. There were no significant differences in the results of sperm-cervical mucus penetration test (CMPT) between spermatozoa fiom vasectomized and fertile men. Antisperm antibodies on the surface of spermatozoa from the vas of vasectomized men were determined by the immunobead test (IBT; 78.6% for IgG, 32.1% for IgA) and sperm cervical mucus contact test (SCMC, 36.4%). The presence of antisperm antibodies on the spermatozoa from the vas of vasectomized men may explain, in part, the lower pregnancy rate after vasovasostomy. These parameters of spermatozoa from the proximal vas of vasectomized men may closely reflect those in the cauda epididymis after vasectomy.     

Effect of vasectomy via inguinal canal on spermatogenesis in rabbits

Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-nine normal male Japanese white rabbits （aged 4- 6 months） were subjected to unilateral close-ended （conventional） or open-ended （the cut end of the juxta-epididymal vas deferens not ligated） vasectomy via the inguinal canal. Ten days and 3 months after operation, testes, epididymides and vasa deferentia were removed and methacrylate resin-embedded sections prepared. The histology of the testis, epididymis and vas deferens was examined under light microscope, and the volume and diameter of the seminiferous tubules were quantitatively studied using stereological methods. Results： Neither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral shamoperated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation. Conclusion： Vasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.     

A randomized,controlled, multicenter contraceptive efficacy clinical trial of the intravas device,a nonocclusive surgical male sterilization

Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device （IVD） implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy （NSV）. IVDs were categorized into two types： IVD-B has a tail used for fixing to the vas deferens （fixed wing） whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A （n = 487）, IVD-B （n = 485） or NSV （n = 487） groups and underwent operation. Follow-up included visits at the 3rd-6TM and 12~ postoperative months, The assessments of the subjects involved regular physical examinations （including general and andrological examinations） and semen analysis. The subjects＇ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests, There were no significant differences in pregnancy rates （0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV） among the three groups （P 〉 0.05）. The cumulative rates of complications at the 12th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method.     

Acute effect of vasectomy on the function of the rat epididymal epithelium and vas deferens

Persistent infertility after apparently successful vasectomy reversal is common. One possible etiology is epididymal epithelial dysfunction resulting in improper sperm maturation after vasectomy reversal. The epididymal epithelium secretes a number of proteins that are thought to be required for the maturation of sperm. Ligation of the vas deferens during vasectomy may affect the synthesis of some of these proteins. In the present study, the function of the epididymal epithelium was assessed at early times after vasectomy (1, 4, and 7 days) by measuring the level of mRNA of 4 secreted proteins: Crisp-1, clusterin, osteopontin, and transferrin. In addition, the site of synthesis of these proteins was determined by immunocytochemistry. The results demonstrated that the expression of Crisp-1 and clusterin, representative epididymal secretory proteins, was largely unaffected by vasectomy. However, osteopontin mRNA increased in the vas deferens in response to vasectomy. Immunocytochemical localization of osteopontin suggested that both infiltrating immune cells and deferential luminal epithelium were responsible for this up-regulation. Transferrin expression was viewed as a marker for immune cells at the site of injury. However, both the caput epididymis and deferential epithelia were found to express transferrin, in addition to immune cells. In conclusion, there appear to be only minor changes in expression of genes encoding epididymal secretory proteins acutely after vasectomy, but, not surprisingly, there was evidence of an inflammatory response after vasectomy.     

Intravasal "toothpaste" in men with obstructive azoospermia is derived from vasal epithelium, not sperm

PURPOSE: Men undergoing vasectomy reversal many years after vasectomy are at increased risk for secondary epididymal obstruction. When this occurs the intravasal fluid is often a thick, white, toothpaste-like material devoid of sperm. In this study we characterize the vasal fluid found in men with a newly described entity, segmental dysplasia of the vas deferens, in which at least 2 distinct sites of vasal obstruction are present. We determine the significance of this fluid in men with obstructive azoospermia. MATERIALS AND METHODS: Three men who underwent scrotal exploration for obstructive azoospermia due to segmental dysplasia of the vas deferens were evaluated. Each underwent scrotal exploration including bilateral vasotomy and testicular biopsy. Intravasal fluid was collected, evaluated microscopically and sent for cytopathological evaluation. RESULTS: All men had isolated segments of the vas 2 to 5 cm in length that were not connected to the epididymis or ejaculatory ducts. We have named this condition segmental dysplasia of the vas deferens. Vasotomy was performed between aplastic segments, revealing thick, white, toothpaste-like material identical to that seen in men with secondary epididymal obstruction undergoing vasectomy reversal. Cytopathological evaluation of this fluid revealed proteinaceous concretions and rare clusters of degenerated columnar epithelial cells, but no sperm or sperm products. CONCLUSIONS: Thick, white, toothpaste-like material is produced between 2 obstructed segments as seen in men with segmental dysplasia of the vas deferens and with secondary epididymal obstruction. Our findings in men with segmental dysplasia of the vas deferens indicate that vasal "toothpaste" must be derived from vasal epithelium, not sperm.     

Comparison of spermatogenic damage induced at 6 months after ligation of the vas deferens at proximal and distal locations in the rabbit

Recent study in rabbits demonstrated that vasectomy via the inguinal canal did not result in any spermatogenic damage 3 months postoperation; this study aimed to determine whether the damage would occur in a longer term. The left or right vas deferens was ligated near the epididymal head (unilateral proximal vasectomy, 12 animals) or via the inguinal canal (unilateral distal vasectomy, 11 animals) in adult male rabbits, with a sham operation being performed on the contralateral side. Six months postoperation, testes, epididymides and vasa deferentia were removed and methacrylate resin-embedded sections prepared to evaluate spermatogenesis by histological (qualitative) and stereological (quantitative) studies. The juxta-epididymal segment of the occluded vas deferens was severely distended (filled with sperm) in 10 of the 11 animals with distal vasectomy and moderately or slightly distended in nine of the 12 animals with proximal vasectomy. Severe spermatogenic damage occurred in seven animals with proximal vasectomy (the juxta-epididymal vas moderately or slightly distended), in only one animal with distal vasectomy (the vas not severely distended). In conclusion, spermatogenic damage occurred at 6 months postvasectomy in some animals, especially those with proximal vasectomy and therefore shorter occluded reproductive tract for sperm storage; the damage was probably intra-tract pressure mediated.     

Analysis of spermatozoa from the proximal vas deferens of fertile men

Fluids from the left and right proximal vas deferens were collected from 105 normal fertile men by cannulating the vas deferens during vasectomy, and sperm parameters analysed. Sperm motility (73.1 k 13.3Y0), normal sperm morphology (75.2 k 11.1"/o), sperm viability (72.7 k 18.8%) and the hypo-osmotic swelling test (73.3 k 19.2%) were in the normal range, compared with that of ejaculated spermatozoa. However, sperm Concentration in the proximal vas deferens (6274.6 k 5103.8 × 10" ml^-' was higher than that in semen. Sperm concentration in the right vas deferens was significantly higher (P<0.05) than that in the left and the percentage of spermatozoa showing abnormal cervical mucus penetration was Significantly higher (47%) for the left than for the right (18%). There were no anti-sperm antibodies on the surface of spermatozoa from the vas deferens as determined by the sperm cervical mucus contact test and immuno bead test. These parameters of spermatozoa from the proximal vas may reflect those of spermatozoa from the human cauda epididymis.