Joseph E. Davis

Immunologic consequences of vasectomy.

Abstract A group of men who had vasectomy for contraceptive purposes were available as a model to study the in situ autoantigenicity of human spermatozoa. Bleedings were obtained before, and at several intervals after, the surgery, and the sera were analyzed for spermagglutinins by the Kibrick method. Titers were measured, considering a minimum of 1:8 as positive. Most titers were moderate, although one was 1:1024. A positive result was found in approximately 55% of the 22 cases. The activity generally appeared about 3 to 6 months after surgery, although in some cases, it developed later. Apparently, two patterns of time-response may occur. Three men had pre-vasectomy antibodies to sperm, but in two of these, the titers increased after the operation.

Disappearance Rate of Spermatozoa from the Ejaculate Following Vasectomy

The authors contend that the end point for disappearance of sperm following vasectomy can be determined in a rapid and consistent manner. Bilateral vasectomy was performed with separate scrotal incisions on 13 men under local anesthesia. 1 1/2-2 cm of vas was resected. A preoperative semen specimen and 10 postoperative specimens were supplied as rapidly as possible. The mean number of days to collect the specimens was 15. An average of 68% of the sperm remaining in the vas distal to the vasectomy are ejaculated at each emission. Aspermia was demonstrated after 6-10 ejaculations following vasectomy.

Influence of norepinephrine on the motility of the human vas deferens: a new hypothesis of sperm transport by the vas deferens.

Segments of human vas deferens contracted spontaneously when perfused with norepinephrine (.1 mcg per ml). Vasa divided into 3 cm segments labeled proximal central or distal (from the epididmymis) were obtained from 27 cadavers. The study also included 68 central segments from vasectomies: 8 from general anesthesia 6 from spinal and 54 from local anesthesia. Contractions were recorded in Locke-glucose solution perfused at 5 ml per minute in a 50 ml bath at pH 7.4 550-560 mm Hg 37 degrees C without preloading against a weak calibrated spring. In experiments without norepinephrine the cadaver segments contracted with increasing frequency from proximal (11-20 per hour) to distal segments (76-104 per hour). Central segments from cadavers exhibited higher force and shorter duration than did proximal or distal segments. Central segments from vasectomies done under general anesthesia produced forceful low frequency contractions compared to those under spinal anesthesia with about one-tenth the force and 4 times the frequency. Local anesthesia blocked spontaneous contraction in all 54 specimens and only 26 responded to norepinephrine. Norepinephrine slightly increased force duration and frequency in all cadaver segments when infused for Hours 2-4 after 2 hours of spontaneous contraction. The authors propose that the intact sympathetic nerve supply lacking after vasovasotomy produces functional ejaculation of sperm.

Significant immunologic factors in male infertility.

A number of patients who suffer from involuntary infertility showed a sperm antibody in the blood serum as detected by 2 different methods of sperm agglutination. These techniques are the Kibrick method (gelatin agglutination test) and the F-D method (tube-slide agglutination test). With the former technique 9% of men and 18% of women from infertile couples had a positive result, while the latter technique revealed 5% of men and 15% of women with positive results. Such cases are termed immunological infertility. Several cases of necrospermia also showed sperm antibody activity. In vasectomized men it has been shown that 50 to 60% have sperm antibody during the first year postoperatively. To develop new methods for treatment of infertility immunosuppression by means of corticosteroid medication was applied. A 7-day regimen of 96 mg. per day methylprednisolone was studied. A drastic decrease of antibody level could be seen in some cases and the wives became pregnant. There has been approximately a 30% success rate in a group of 15 such couples.

Cutaneous metastases from prostatic carcinoma

A case of prostatic adenocarcinoma associated with extensive cutaneous metastases and malignant acanthosis nigricans is reported. Pertinent literature is reviewed. The pathogenesis of the possible mechanism of the development of cutaneous metastases in this as well as other related cases is discussed.

Renal adenocarcinoma: prognostics and treatment reflected by survival.

A retrospective study of 164 patients with renal adenocarcinoma has reconfirmed the highly malignant potential of this neoplasm. Stage and size of the tumor appear to be the best prognostic parameters. Radical surgery appears to have improved survival statistics. Follow-up must be indefinite since late metastases are not uncommon.

Hypernephroma presenting as solitary metastasis to penis

Abstract A rare case of primary renal neoplasm metastatic to the penis in a fifty-seven-year-old man is presented. The unusual features of a renal tumor on the right side with initial presentation as malignant priapism, and invasion of the urethral lumen without hematuria or other urinary symptoms are discussed. Pertinent literature is reviewed.

The Nitrofurans as Sperm-Immobilizing Agents their Tissue Toxicity, and their Clinical Application in Vasectomy * †

Nitrofurantoin sodium and nitorfurazone, in certain critical concentrations, have the ability to immobilize spermatozoa. In this study, this effect was consisitent with both 5:1, and 10:1 dilutions. Histologic examination of the effects of these drugs as intraoperative vas irrigants revealed no apparent tissue toxicity in the guinea pig. Clinically, we found intraoperative vas irrigation with both of these nontoxic drugs to be of value in attaining azoospermia immediately postvasectomy. Therefore, they appear to be useful supplements to vasectomy.

Vasectomy: benefits versus risks.

The benefits and risks of modern vasectomy are presented, including a discussion of precautions and contraindications, the incidence of specific complications and suggestions for minimizing them, and the incidence of and reasons for procedure failures. Long‐term side effects, including psychological sequelae, are also discussed.

Effect of vasectomy on guinea pig testes

Abstract The effects of vasectomy on the guinea pig testes were histologically assessed at weekly intervals. Degenerative changes were seen at eight weeks postvasectomy which were noted to be completely reversed in the sixteen-week specimens.