Male fertility after spermatocele formation from tunica vaginalis in patients with bilateral vas agenesis.

To form spermatocele from vaginal layers as a sperm reservoir and intra-uterine insemination (IUI) in infertile men with bilateral vas agenesis (BVA), we studied 19 patients with azoospermia due to BVA referred to our infertility clinic from March 1992 until May 2003. The ages of the patients ranged from 20-41 (mean 29.6+/-5.8) years. After physical examination, hormone assay, testis biopsy, and confirming normal spermatogenesis, we have performed 23 alloplastic spermatoceles from the tunica vaginal layers in 11 patients. We retrieved sperms and performed IUI in 6 patients' wives 3 months post-operation when scrotal sonography revealed spermatocele with a good volume of seminal liquid. Among 6 patients' wives, 2 successful pregnancies occurred, and 2 normal babies (one boy with normal bilateral vas and one girl) were delivered successfully by cesarean section. We conclude that although the method of choice for fertility in BVA in artificial reproductive therapy era is percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection (ICSI), but when the sophisticated facilities are not available or cost-effectiveness is matter of concern, alloplastic spermatocele from tunica vaginalis and IUI may be a viable option.

Synergistic action of steroids and spermatocele fluid on in vitro proliferation of prostate stroma.

PURPOSE: Our goal is to understand human prostate growth phenomena potentially important to BPH development and growth. The objective of the present study is to characterize in vitro prostate stromal proliferative factors in testis epididymal secretions. MATERIALS AND METHODS: Human spermatocele fluids were used as a source of testicular epididymal plasma (STEP). Primary cultures of human prostate stromal cells were routinely grown in RPMI-1640 with 10% fetal bovine serum. During a 6-day experimental period, cells were cultured in RPMI-1640 in the absence of serum but supplemented with ITS. Whole STEP, ether stripped STEP, or heparin affinity column treated STEP was included in the culture medium with and without the addition of testosterone (T), dihydrotestosterone (DHT), or estradiol (E). Results of these treatments were assessed by cell counts. Antibodies against smooth muscle myosin heavy chain, smooth muscle alpha actin, and prolyl-4-hydroxylase were utilized in immunocytochemical characterization of cultured cells. RESULTS: Whole STEP stimulated prostatic stromal cells derived from prostates of 15, 45, 70 and 72-year-old men. Treatment of STEP by ether stripping or heparin affinity column exposure did not result in a significant reduction in cell counts. With the exception of the 15-year-old specimen, addition of T or DHT to ether stripped STEP resulted in a significant increase in cell counts over that of ether stripped STEP treatment alone. Preliminary immunocytochemical evaluation indicated the presence of variable mixture of fibroblasts, myofibroblasts, and smooth muscle cells in these cultures. CONCLUSIONS: These in vitro observations indicate that testis epididymal secretions contain androgen/STEP synergistic and androgen independent STEP factors promoting prostate stromal growth. These factors are not heparin binding. These observations are consistent with the concept that, in addition to the production of steroids, the testis produces non-androgenic factors that act in concert with, as well as independently of, androgen to stimulate prostatic growth.

Effect of spermatocele fluid on growth of human prostatic cells in culture.

The present study was carried out to investigate whether testicular fluid derived from a spermatocele contains substance(s) that promote the growth of human prostatic cells in culture. Human spermatocele fluid was centrifuged to sediment spermatozoa. The supernatant was then added to cultures of human prostatic stromal or epithelial cells that were isolated from surgical specimens of benign prostatic hyperplasia. Addition of spermatocele fluid in quantities of 1 microgram/ml of protein resulted in a significant increase in the number of both prostatic stromal and epithelial cells at the end of a 6-day culture period. Human serum at equivalent protein concentrations in the culture medium had no stimulatory effect. At least two separate growth-promoting factors were found in spermatocele fluid, one for stromal cells and one for epithelial cells. The mitogen for stromal cells was heat labile and persisted after treatment with activated charcoal. The factor for epithelial cells was heat stable but was removed by charcoal treatment. These observations are consistent with the concept that the human testis secretes nonandrogenic substances that can promote prostatic growth.

Properties of human epididymal sperm obtained from an alloplastic spermatocele: motility assessment and penetration of zona-free hamster oocytes in the presence and absence of caffeine.

Sperm were collected over a period of months from a human alloplastic spermatocele implanted at the corpus/caudal epididymal junction and were evaluated for their maturity, motility, and ability to capacitate and acrosome react, as assessed by the hamster zona-free oocyte sperm penetration assay (SPA). A mean of 11 X 10(6) sperm were obtained with each aspiration, with 34% to 40% being mature, normal forms. Motility was poor; 15% +/- 5% showing nonprogressive movement. SPA results were 22% +/- 3% oocyte penetration. Addition of 7.5 mM caffeine markedly enhanced motility and improved the SPA results. After 30 minutes' exposure, the motility was 45% +/- 5%, with all spermatozoa exhibiting progressive movement. This stimulation was maintained over a 24-hour period. When caffeine was present during the 2-hour preincubation for the SPA, penetration rates increased to 50% +/- 10% (P less than 0.05). These results demonstrate that the poor-quality sperm retrieved from a human alloplastic spermatocele can be improved with exogenous stimulation and suggest that their fertilizing capacity may be enhanced by this treatment.

How to increase the motility of spermatozoa from the epididymis of bulls and alloplastic spermatoceles in minipigs.

The motility of spermatozoa from the head and tail of the epididymis in bulls was studied. Qualitatively and quantitatively, the motility of spermatozoa from the cauda was distinctly better than that from the caput. It was possible to achieve a highly significant increase in the motility of epididymal spermatozoa from the caput as well as the cauda area using caffeine or a caffeine-kallikrein mixture. Above all, motility stimulants improved the local motility of the epididymal spermatozoa as compared to twitching and progressive motility. The motility of caudal spermatozoa was increased by 100%, corresponding to local movement of 59% of the total number of sperm cells. It was possible to demonstrate an increase in the almost totally absent motility of the caput spermatozoa to 27% local motility. Application of kallikrein without addition of kininogens led to no significant change in spermatozoa motility. By the addition of caffeine, it was possible to increase the motility of minipig epididymal spermatozoa taken by puncture from alloplastic spermatoceles significantly. In 23 aspirates, a prompt increase in the percentage of locally motile "spermatocele spermatozoa" from 12% to 23.5% was observed.

Vas deferens aplasia: clinical and anatomical features of 90 cases.

Out of 531 patients with excretory azoospermia, scrotal exploration for attempted epididymo-vasostomy showed vas aplasia in 90 of them (= 17%). In the latter group complete bilateral agenesis of the vas was seen in 64 cases while the remaining showed partial vas aplasia or different findings on both sides. The anatomical findings were classified into various groups of frequency. The typical peroperative picture included extensive paraepididymal bodies of fat, venous conglomerations at the place of missing epididymal structures and frequent Morgagni's hydatides and spermatoceles. Preoperative palpation and surgical findings did not correlate. Laboratory examination of the ejaculate showed volume and fructose values below the norm in the majority of cases. Electron- and light-microscopy showed dissolution of spermatozoa and sperm-phagocytosis within the dilated epididymal canal as well as within the bordering tissue. Since laboratory- and physical examinations are misleading in some cases with vas aplasia surgical exploration is necessary. A cup-shaped Silicone-Dacron reservoir was implanted upon the remaining epididymal structures in 16 men with vas aplasia, but insemination of the aspirated material in their wives did not lead to any lasting pregnancy. In other centers 3 conceptions and normal births were obtained by this method.

[Dissection of spermatoceles and fertility (author's transl)]. / Spermatozelenoperation und Fertilität.

The majority of spermatoceles originate in retention cysts of the vasa efferentia. Cystic embryonic remnants of the testis and epididymis are not so frequent. Only 10 of 20 patients undergoing surgical treatment of unilateral, singular spermatoceles preoperatively showed normozoospermia. Excision of the spermatocele in more than 50% of our patients caused permanent deterioration of their spermiogramm. The number of sperms was reduced to less than the half of the preoperative counts. Obstruction of the epididymal duct caused by postoperative cicatrices is thought to be the reason. In consequence of these results operative treatment of spermatoceles should be though over. Our series clearly shows that the dissection of a spermatocele by no means should be practiced by way of treating infertility.