Effect of vasectomy on humoral and cell-mediated immunity in monkeys with experimentally induced atherosclerosis

The development of humoral and cell-mediated immune responses and circulating immune complexes following vasectomy were studied in rhesus monkeys fed a high cholesterol (atherogenic) diet. Four groups of monkeys were studied: (i) sham-vasectomized males fed a normal stock diet, (ii) sham-vasectomized males fed an atherogenic diet, (iii) vasectomized males fed a normal stock diet, and (iv) vasectomized males fed an atherogenic diet. Monkeys were observed for a period of 1.5 years. Sperm agglutinins and immobilizins in serum were detected in 100 and 60%, respectively, of vasectomized monkeys fed stock diet. In contrast, 60% of vasectomized monkeys fed an atherogenic diet showed agglutinins in their sera and only 20% exhibited immobilizins. The sensitization of lymphocytes by seminal plasma antigens was of a lower order in vasectomized monkeys fed an atherogenic diet as compared to those maintained on a stock diet. Circulating immune complexes (CIC) were present in both the groups of vasectomized monkeys but the level was higher in animals fed an atherogenic diet. The aortic atherosclerosis score was increased significantly in vasectomized monkeys fed an atherogenic diet, whereas the coronary atherosclerosis score was increased both in vasectomized males and in animals fed an atherogenic diet.     

A novel instrument-independent no-scalpel vasectomy - a comparative study against the standard instrument-dependent no-scalpel vasectomy

An instrument-independent no-scalpel vasectomy (IINSV) technique is reported. This technique does not use the standard specific instruments, but comparatively retains the advantages of minimally invasive instrument-dependent no-scalpel vasectomy (IDNSV). Between July 1999 and June 2002, 449 men were prospectively randomized to be vasectomized at two hospitals in Taipei. Of those who accepted, 215 underwent IDNSV at one hospital and the remaining 234 underwent IINSV at the other. The intra-operative conditions of each group were recorded. The postoperative pain and life conditions were self-reported through a questionnaire that had been carefully designed prior to the operations, in which the pain level was assessed using a 10-cm visual analogue scale under varying situations. Men vasectomized using the IINSV method experienced less operation time and postoperative complications (haematomas, infections and granulomas) (p < 0.05). There were no significant differences between the two groups with respect to incision length, postoperative pain, pain at coitus, time of return to work, time of resuming intercourse, self-reported satisfaction in sexual life, postoperative psychological status, postoperative body weight change and vasectomy failure as evidenced by sperm analysis (p > 0.05 for all items). Thus, the IINSV technique can offer an alternative option for vasectomists whenever the specific instruments of standard no-scalpel vasectomy are unavailable. The IINSV technique shortens the operation time and reduces the incidence of operative complications when compared with the IDNSV technique, while still retaining the advantages of minimally invasive vasectomy.     

Plasma reproductive hormones in normal and vasectomized Chinese males

Plasma reproductive hormones (testosterone, LH, FSH and prolactin) were measured in 298 normal healthy males aged 30-73 years from rural areas of Sichuan Province, People's Republic of China, and in 505 similar men vasectomized between 1 year and 25 years previously. Age-related increases in LH and FSH but not in testosterone or prolactin were noted in normal men. No adverse effects of vasectomy were observed apart from a 16% increase in mean LH levels in the vasectomized compared to non-vasectomized men of similar ages.     

Histologic changes in the mouse testis after bilateral vasectomy

Aim: To study the effect of vasectomy on histological appearance of the testis. Methods: Parkes strain mice were used as the animal model; they were bilaterally vasectomized (Vx) or sham-operated (So) and killed at intervals of 4, 6, 9, and 12 months after the operation. Testes were excised from 5 Vx and 5 So mice at each interval and processed for histological examination. Results: Testes of So mice showed normal histological features. By contrast, marked alterations were observed in the seminiferous tubules in testes of Vx mice, except in those killed 4 months after the operation. The seminiferous epithelium in the tubules was only 2 - 3 layers thick and showed much depletion of germ cells; in severe cases, the epithelium consisted of only a thin layer of Sertoli cells, spermatogonia and a few spermatocytes. Exfoliation of germ cells, occurrence of multinucleated giant cells and vacuolated appearance of the epithelium were of common features in the tubules. Furthermore, lumen of the rete testis in Vx mice was greatly dilated and showed accumulation of spermatozoa with immature germ cells; in mice vasectomized for 6 - 12 months, several macrophages ingesting spermatozoa were often observed in the lumen of the rete testis. Spermatic granuloma was also sometimes noticed in corpus or in cauda regions of the epididymis in mice vasectomized for 6 - 12 months. Conclusion: We suggest that consequences of vasectomy should be thoroughly understood in order to make this method rather more popular as a reversible method of male contraception.     

Does vasectomy have long-term effects on somatic and psychological health status?

All the major international articles on the somatic and psychological consequences of vasectomy published over the last 10 years have been reviewed and analysed. Although some experiments on animals have revealed harmful effects, none of the large-scale epidemiological studies has pointed to any increase in health risks (cardiovascular, hypertensive, psychiatric) in vasectomized men. The contradictions which arise between the clinical and large-scale epidemiological studies may be the result of methodological or experimental conditions. As our knowledge stands at present it can therefore be considered that vasectomy has no major effects on the physical or mental health of men.     

Early and late long-term effects of vasectomy on Zn, Cd, and Cu levels in prostatic fluid and serum

Aim: To evaluate the early and late long-term effects of vasectomy on the serum and prostatic fluid trace elements.Methods: In 37 vasectomized and 25 non-vasectomized (control) men, the Zn, Cd and Cu levels in the serum andprostatic fluid were measured by means of inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Re-suits: No significant difference was found in the prostatic Zn, Cd and Cu levels between the vasectomized and controlgroup. The Zn level in the semm were significantly lower in the vasectomized men than in the controls (11.04 and 13.54 umol/L, respectively; P < 0.05), while the serum Cd and Cu levels were not significantly different between thetwo groups. Conclusion: Vasectomy may decrease the serum, but not the prostatic Zn levels. Its pathophysiologicalsignificance is worthy of further investigation.     

Extra-epididymal spermatozoa express nuclear abnormalities

Extra-epididymal spermatozoa account for approximately a third of all spermatozoa found in the normal human ejaculate. Whilst remaining outside of the testes at core body temperature, the functional competence of spermatozoa, including cell motility and fertilizing capacity, diminishes. By examining spermatozoa found in the seminal fluid of recently vasectomized men, this study has investigated the nuclear changes that occur in spermatozoa whilst persisting in sites distal to the epididymis. Spectral recordings of spermatozoa stained with the nucleic acid dye, toluidine blue and the sperm chromatin structure assay (SCSA) were performed. Toluidine blue staining of human sperm DNA is an effective predictor of abnormal protamine disulphide crosslinking and chromatin condensation. Using flow cytometry, the SCSA determines the sensitivity of sperm DNA to acid-induced denaturation, providing a measure of chromatin and DNA damage. Abnormal protamine disulphide crosslinking and chromatin condensation was significantly higher in spermatozoa from patients after vasectomy when compared to normozoospermic controls (p < 0.01). Additionally, spermatozoa from vasectomized donors were significantly more sensitive to acid-induced denaturation than were normozoospermic donors (p < 0.05). The results indicate that spermatozoa surviving in extra-epididymal sites are more likely to possess DNA and chromatin abnormalities than those present in the testes and epididymis. These changes may partly explain the depletion of cell viability and fertilizing capacity of extra-epididymal spermatozoa which has been reported previously.     

Testicular Effects of Vasectomy in Rats: An Ultrastructural and Immunohistochemical Study

Objectives. The correlation between infertility and morphofunctional alterations following vasal occlusion is not clearly understood. Although a correlation has been found between the expression of a high titer of antisperm antibodies and the status of infertility, the relationship between the immunoglobulin (Ig) depositions in the testis and ultrastructural alterations of the peritubular structures has not been clearly established. The objective of this study is to explain the etiopathogenesis of diffuse and focal testicular lesions caused by vasal obstruction.Methods. Unilateral vasectomy was performed on adult male rats. Ultrastructural changes of testicular tissues and immunostaining affinity of peritubular structures with anti-actin, anti-vimentin, anti-laminin, and anti-immunoglobulin G (anti-IgG) antibodies were analyzed.Results. In an ultrastructural study, vasectomized animals presented abundant collagen fibril accumulation in the peritubular area. In testis with intense IgG antibodies, staining revealed weak immunostaining of peritubular myoid cells with anti-actin antibodies, but intense immunostaining with anti-vimentin antibodies. The tubules of rats with no IgG deposition on peritubular structures revealed intense immunostaining with anti-actin antibodies but scant immunostaining with anti-vimentin antibodies. Anti-laminin deposits decreased severely in most of the tubules demonstrating intense IgG deposition.Conclusions. Our findings suggest that spermatogenesis deteriorates more severely in testes with dense IgG deposition. The sclerosis of the lamina propria in cases with vasal occlusion is secondary to alterations in the peritubular myoid cells. With the progressive changes that occur in the peritubular myoid cells or differentiation of the peritubular myoid cells that acquire active cell characteristics, collagen accumulation adjacent to these cells increases markedly. The alterations of the peritubular myoid cells reported here may be caused by alterations in basement membrane structures.     

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.     

The long-term influence of vasectomy on prostatic volume and morphology in man

During the past two decades several papers have described the changes in prostatic secretory capacity following vasectomy. Based upon results indicating a reduction of secretory function, it was suggested that even prostatic size and the incidence of benign prostatic hyperplasia (BPH) might be altered after the operation. In this study, which included 56 males who had been vasectomized 8 years previously and 56 age-matched control persons, transrectal ultrasonic scanning of the prostate was used for exact measurements of the prostatic volume and for the investigation of intraprostatic echo pattern. The total prostatic volume, the volume of the periurethral gland, and the volume of the peripheral zone were not influenced by the vasectomy; nor was the growth rate of these zones affected. In the vasectomy group, the frequency of adenomatous prostates was 19.6%, whereas 30.3% of prostates in the control group had ultrasonic signs of BPH. However, this is not a statistically significant difference. Subdividing the material according to age did not reveal altered BPH frequency in any age group when vasectomized and controls were compared.     

Sialoglycoproteins of ejaculated human spermatozoa and seminal plasma

Ejaculated human sperm were found to possess three major sialoglycoproteins with molecular weights of 30 000, 14 000 and 12 000 and one minor species of 18 000. Liquefied seminal plasma from normal donors contain two major sialoglycoproteins with molecular weights of 17 000 and 15 000 and two minor species of 70 000 and 54 000. In contrast, the liquefied sperm-free semen of vasectomized men had two major species of sialoglycoproteins of 20 000 and 18 000 daltons plus two minor species of 54 000 and 40 000.     

Long-term effect of vasectomy on spermatogenesis in men: a morphometric study

Spermatogenic damage may occur after vasectomy, and the damage is pressure mediated, occurring when the occluded reproductive tract is unable to accommodate additional sperm produced by the testis. This study aimed to determine the long-term effect of vasectomy on spermatogenesis in humans and clarify how the balance between sperm production in the testis and sperm storage in or removal from the tract might be maintained. During inguinal hernia repair, an open biopsy was performed to obtain testicular tissue blocks from 51 Chinese men (aged ≥50 years), of whom 25 (control group) had not undergone vasectomy and 26 (vasectomized group) had undergone bilateral vasectomy 22–42 years before. Methacrylate resin-embedded testicular sections were made, and morphometric studies were performed using light microscopy. In addition, sizes of the testis and epididymis were estimated with ultrasonography. The testicular tissue blocks obtained from one control and seven vasectomized men consisted almost completely of connective tissue. In the other 43 men, significant differences were not found between the two groups in the testicular or epididymal size, qualitative histology or quantitative parameters including the mean diameter or volume fraction of the seminiferous tubules. In conclusion, sperm production and sperm storage/removal reached a static equilibrium after vasectomy, likely due to spermatogenic degeneration or less sperm production as a result of aging or due to vasectomy-induced testicular (interstitial) fibrosis. Thus, complications that might occur in association with overproduction of sperm and distension of the tract would disappear or be relieved with time.     

Presence and distribution of leucocyte subsets in the murine epididymis after vasectomy

Male mice were vasectomized by 'open-ended' or 'closed' techniques. After 4 weeks the cell-mediated immune reactions were compared with those of sham-operated animals by immunohistochemical localization of leucocytes, using specific monoclonal antibodies. Macrophages and MHC class II antigen-positive cells were the major cell types to appear in all regions of the epididymis after both types of operation. There was recruitment of T-helper/inducer leucocytes but not of T-suppressor-cytotoxic cells. An increased presentation of macrophage-migration inhibiting factor antigen appeared in interstitial and peritubular locations. After 'closed' and 'open-ended' vasectomy granulomata developed in the epididymis. The sperm-containing lumen of these granulomata was invaded by macrophages, MHC class II-positive cells and T-helper/inducer lymphocytes. This mouse model thus reveals a significant epididymal inflammatory response of the epididymis to vasectomy.     

膀胱癌患者红细胞免疫功能变化的观察

为了观察膀胱癌患者红细胞免疫功能的变化状况，对４１例膀胱癌患者（观察组）红细胞免疫功能和血清循环免疫复合物进行检测，并且与５５例健康对照组进行比较，结果观察组红细胞Ｃ３ｂ受体花环率（ＲＣＲ）明显低于健康对照组，而红细胞免疫复合物花环率（ＲＣＩＲ）明显增高，血清循环免疫复合物（ＣＩＣ）含量亦明显高于健康对照组（均Ｐ〈０．０１），Ｔ１－２期膀胱癌患者ＲＣＲ水平低于Ｔ３－４膀胱癌患者，而ＲＩＣＲ水平则明     

Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats

PURPOSE: Vasoepididymostomy is a technically challenging and complex microsurgical procedure. Recently a new triangulation end-to-side microsurgical technique was reported that allows intussusception of the epididymal tubule into the vasal lumen, resulting in a higher clinical patency rate of 92% with shorter operative time in preliminary clinical studies. We performed a prospective controlled randomized study comparing the patency rate, postoperative sperm granuloma rate and operating time of conventional and intussusception end-to-side vasoepididymostomy in previously vasectomized rats. MATERIALS AND METHODS: We randomized 42, 6-week-old male Wistar rats into 4 groups, including 6 into the sham operation, and 12 each into the control, conventional end-to-side and intussusception end-to-side vasoepididymostomy groups. Bilateral 2-clip vasectomy was performed in all animals except those in the sham operation group. Bilateral intussusception or conventional end-to-side vasoepididymostomy was performed in the assigned animals 2 weeks after vasectomy. Animals in the control group underwent vasectomy only. In the sham operation group the testes were mobilized out of the scrotum and then returned. Rats were sacrificed at 8, 12, 16 and 24 weeks, respectively. The anastomosis and vasectomy sites were inspected for sperm granuloma. To assess patency the abdominal end of the vas was transected and intraluminal fluid was examined microscopically at 400x magnification for the presence of motile sperm. Patency was further confirmed by performing retrograde indigo carmine vasography through the anastomoses. RESULTS: In the intussusception and conventional groups the patency rate was 91.7% and 54.2% (p = 0.004), the sperm granuloma rate was 20.8% and 58.4% (p = 0.035), and average operative time was 65.8 and 67.7 minutes (p = 0.197), respectively. CONCLUSIONS: Intussusception end-to-side vasoepididymostomy is superior to conventional end-to-side vasoepididymostomy with respect to the patency and postoperative sperm granuloma rates. Further investigations are required to confirm such findings clinically in humans.     

Biochemical analysis of human seminal plasma. I. Fructose, ascorbate, cholesterol, adenosine triphosphatase and lactic dehydrogenase

Seminal levels of fructose, ascorbate, cholesterol, adenosine triphosphatase (ATPase) and lactate dehydrogenase (LDH) were estimated in human males divided into normal (Group I), azoospermic (Group II), infertile (Groups III, IV and V with different sperm numbers) and vasectomized (Group VI) cases. The fructose level of the normal subjects (Gr. I) recorded the lowest geometric mean value and that of the azoospermic patients being the highest; other groups registered intermediate values. A significant difference was evident in the level of ascorbate between normal (Gr. I) and azoospermic (Gr. II) conditions, the level being higher in the normal group. The seminal ATPase activity of different groups varied inversely with the number of sperms, the mean value of the normal (Gr.I) being the lowest. The results suggest that determination of seminal ATPase and ascorbate levels is likely to yield some useful information about the semen quality.     

Biochemical analysis of human seminal plasma. II. Protein, non-protein nitrogen, urea, uric acid and creatine

Seminal levels of protein, non-protein nitrogen (NPN), urea, uric acid and creatine were determined in human males divided as normal (Group I), azoospermia (Group II), infertile (Groups III, IV and V) with different sperm numbers and vasectomized (Group VI) cases. The geometrical mean level of seminal protein of Gr. I and Gr. V were significantly greater than that of Gr. IV. No significant difference in the levels of NPN and urea between any of the groups revealed. The seminal creatine level of Gr. I was significantly higher than that of Gr. III which in its turn was greater than that of Gr. VI, which recorded a value lowest of all the groups. Mean levels of uric acid of Gr. I was significantly greater than those of other five groups, taken individually. A direct correlation between uric acid level and sperm counts is an important observation that has emerged from this study.     

Incidence of circulating immune complexes in patients with acute poststreptococcal glomerulonephritis and in patients with streptococcal impetigo

In an attempt to further study the possible contribution of circulating immune complexes (CIC) in the pathogenesis of acute poststreptococcal glomerulonephritis, 61 patients with APSGN were studied during the first three weeks of the disease, and 13 patients with noncomplicated streptococcal impetigo as a control group. C1q solid phase ELISA and Conglutinin (K) solid phase ELISA were used to measure the levels of immune complexes. The incidence of CIC in a single serum sample from patients with APSGN was 48%. Elevated levels of immune complexes were found in 46% of the patients with streptococcal impetigo. The absolute levels of CIC were comparable in both groups of patients. No correlation was found among the presence of CIC and the clinical, immunoserological or pathological findings of the disease. Our results do not support the hypothesis that trapping of the circulating immune complexes play an important role on the renal injury poststreptococcal infection. Instead, we suggest that CIC are an epiphenomena present in APSGN, and may represent rather a systemic inflammatory immune response in patients with group A streptococcal infection.     

Mitochondrial Efflux of Citrate and Isocitrate Is Fully Dispensable for Glucose-Stimulated Insulin Secretion and Pancreatic Islet β-Cell Function

The defining feature of pancreatic islet β-cell function is the precise coordination of changes in blood glucose levels with insulin secretion to regulate systemic glucose homeostasis. While ATP has long been heralded as a critical metabolic coupling factor to trigger insulin release, glucose-derived metabolites have been suggested to further amplify fuel-stimulated insulin secretion. The mitochondrial export of citrate and isocitrate through the citrate-isocitrate carrier (CIC) has been suggested to initiate a key pathway that amplifies glucose-stimulated insulin secretion, though the physiological significance of β-cell CIC-to-glucose homeostasis has not been established. Here, we generated constitutive and adult CIC β-cell knockout (KO) mice and demonstrate that these animals have normal glucose tolerance, similar responses to diet-induced obesity, and identical insulin secretion responses to various fuel secretagogues. Glucose-stimulated NADPH production was impaired in β-cell CIC KO islets, whereas glutathione reduction was retained. Furthermore, suppression of the downstream enzyme cytosolic isocitrate dehydrogenase (Idh1) inhibited insulin secretion in wild-type islets but failed to impact β-cell function in β-cell CIC KO islets. Our data demonstrate that the mitochondrial CIC is not required for glucose-stimulated insulin secretion and that additional complexities exist for the role of Idh1 and NADPH in the regulation of β-cell function.     

The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children

OBJECTIVE: To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal. PATIENTS AND METHODS: The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6-14.5, and seven males, mean age 8 years, range 5-20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow-up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient. RESULTS: Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow-up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection-free 16 months (two) and 6 years later. CONCLUSION: CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost-effectively.