Fletcher C. Derrick

Clinical significance of sperm antibodies in infertility

Sperm antibody (AB) titers, determined by passive hemagglutination and cytotoxicity assays, were found to be elevated in 62 males and 46 females of 103 couples with primary infertility; 15 males and 12 females of 25 couples with secondary infertility; 10 males and 8 females of 18 couples with histories of repeated abortion; 21 males and 17 females of 25 couples in which the husband had a history of prostatitis; and 29 males and 17 females of 38 couples in which the husband had oligospermia. Of the couples in which one or both partners had elevated sperm AB titers, only 4 achieved pregnancy: 3 from the group with secondary infertility, all of which ended in spontaneous abortions, and 1 in which the husband was oligospermic. This suggests an etiologic role of sperm immunity in infertility. Immunosuppressive treatment of autoimmune males with prednisone (15 mg/day for 3 weeks to 6 months) resulted in significant decreases in AB titers. Pregnancies were achieved by 9 of 25 couples after treatment (36%). The observed increase in pregnancy rate in the prednisone-treated versus untreated groups of couples with elevated sperm AB titers was significant (P less than 0.02).

Vasovasostomy: results of questionnaire of members of the American Urological Association.

A questionnaire regarding vasovasostomy was sent to every member of the American Urological Association. From the 2775 questionnaires sent there were 1363 replies. 821 doctors had never attempted the operation. 542 had performed the operation or more times. There were 388 cases of vasovasostomy with a suture material. No stent or splint was used and the success rate of pregnancy was 10.9%. With the stainless steel wire pull-out technique 804 operations were done with a 19.9% success rate of pregnancy. In 242 cases internal cannular of silicane was used. The pregnancy rate was 20.9%. There were 196 cases of nylon pull-out stent with a 26% success rate. Recorded in the series were 620 positive sperm counts averaging 38% sperm return to semen. The average pregnancy rate with all procedures was 19.5%. The authors point out that the discrepancy between return of sperm to semen and pregnancy may be due to a factor present in the female partner.

Bacterial effect on sperm motility

Human semen containing normal number of sperm was exposed to concentrations of Escherichia coli varying from 500 to 10-8 colonies per cubic centimeter. A significant decrease in motility was abserved at 10-6 colonies per cubic centimeter.

Interference of Human Spermatozoal Motility by Trichomonas Vaginalis

Human spermatozoa were exposed to concentrations of live Trichomonas vaginalis varying from 10(4) to 10(7) organisms per ml. A striking decrease in spermatozoal motility ensued. The possible role of trichomoniasis in human reproductive failure is considered.

Interference of Human Spermatosoal Motility and Spermatozoal Agglutination by Candida Albicans

Human spermatozoa were exposed to concentrations of 10(2) to 10(7) organisms per ml. Candida albicans. A subsequent striking decrease in spermatozoal motility and significant agglutination were observed. The possible role of mycotic genital tract infections in human infertility is considered.

Benign Lesions of the Tunica Albuginea

Although most testicular masses are malignant we present 7 cases to demonstrate that benign lesions of the tunica albuginea do occur and that these may be a source of diagnostic confusion. Consideration should be given to the possibility of a benign lesion of the tunica albuginea when the lesion is small, discrete, painless and projecting above the surface of the tunica albuginea. All of our patients were referred to us with a tentative diagnosis of testicular malignancy. We do not wish to decrease the importance of vigilance concerning testicular masses but the cases presented herein demonstrate that all masses of the testis are not malignant.

Experiences with a reversible vas device.

Experience with the Brodie reversible intravas device (RIVD) made of polypropylene is described. After the usual exposure the lumenl of the vas is dilated and the RIVD placed in the testis end of the vas through an incision. It is secured with a suture outside the vas. The device can be removed through a small linear incision. Vas continuity is not interrupted. This device has been inserted into 13 male volunteers and left in place 5-15 months. Sperm counts were done at monthly intervals. 10 patients were sterile and 3 patients were never sterile. The device eroded through 1 vas on each of the 3 nonsterile patients. In 1 patient an inflammatory reaction occurred on 1 side with digestion of the device. Among 9 patients from whom the device had been removed 6-13 months previously none has had sperm in his semen. The device is still retained by 1 patient. It is thought that theoretically the device is excellent however it is probably too large thus causing necrosis of the vas. When the device is removed the vas undergoes scarring and atrophy and becomes completely occluded.

Renal Calculi in Association with Hyperparathyroidism: A Changing Entity

Hyperparathyroidism as a cause of renal calculous disease has decreased considerably during the last 50 years. From 1972 to 1977, 5,034 cases of calculous disease were seen in 5 major hospitals in South Carolina and only 9 patients had hyperparathyroidism as the underlying etiology. There is a 0.178 per cent incidence of hyperparathyroidism as a cause of renal calculous disease in this series, or between 1 and 2 patients per 1,000 cases of stone disease. This finding is compared to a high incidence of 8 per cent in 1934. This change probably is owing to the large-scale use of multiphasic screening blood tests.

Leydig cell tumor in identical twin.

A case is presented of an identical twin who had an interstitial cell tumor of the testis removed, and comparison is made with his identical brother over an ensuing six-year period. The dramatic effects of the interstitial cell tumor are clearly shown in the comparison of the two males over this six-year period. To our knowledge this is the only such case in the world literature.

Kidney stone disease: Evaluation and medical management

Over the past 15 years we have developed a protocol for evaluation and medical management of urinary calculi that has proved quite effective. For all patients we include plain x-ray films of the urinary tract, intravenous pyelograms, urine cultures and sensitivity studies, serum and 24-hour urinary chemical determinations, and analysis of any stones recovered. Although the cause of calcium stones, the most common type of urinary calculi, has not been established, specific treatment regimens have been devised. Maintenance of a dilute urine remains the mainstay of therapy, and diuretics, alkalinizing or acidifying agents, and various specific drugs may be indicated, depending on laboratory findings. Surgery is not indicated unless the stone is large, is in the upper part of the urinary tract, or shows no signs of movement.