Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? a prospective randomized trial

Mason, Robert L.; Dodds, Lachlan; Swami, Satchi

doi:10.1016/s0090-4295(01)01566-7

Cited by 30 publications

(13 citation statements)

References 16 publications

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“…Berthelsen, 12 also using sterile water for perfusion, noted no difference in time to azoospermia between the perfused and nonperfused groups, but of 59 patients randomized at the time of vasectomy, only 38 (64%) completed their follow-up semen checks. Similarly, Mason et al 13 randomized 200 patients using sterile water for perfusion of the vas deferens. Of the 163 patients (82%) with follow-up information, no difference in time to azoospermia was noted between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Clinical Trial of the Effect of Intraoperative Saline Perfusion on Postvasectomy Azoospermia

Eisner

Schuster

Rodgers

et al. 2004

The Annals of Family Medicine

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BACKGROUND We wanted to determine whether a saline fl ush during vasectomy would reduce the time needed to reach azoospermia.METHODS During vasectomy men were randomly assigned to fl ush the prostatic end of the vas deferens with 10 mL of normal saline (intervention group, n = 50), while the remaining men (n = 56) served as controls. Sperm counts were performed on the immediate postprocedure urine specimen and on semen samples at 1, 6, and 12 weeks after vasectomy. RESULTSThe postprocedure urine specimens from the intervention and control groups contained 29.2 x 106 and 0.004 x 106 sperm, respectively (P <.001). Total sperm counts in the ejaculate for intervention and control groups at 1, 6, and 12 weeks were (in millions of sperm): 14.1 and 13.8, 0.4 and 8.0, and 0.0 and 0.011, respectively (P >.05 at all time points). There was no difference in the rate at which the men in the 2 groups achieved azoospermia.CONCLUSIONS Vasal perfusion with saline during vasectomy was effective in removing sperm from the distal vas; however, perfusion did not increase the rate at which men achieve azoospermia.

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Section: Discussionmentioning

confidence: 99%

A Randomized Clinical Trial of the Effect of Intraoperative Saline Perfusion on Postvasectomy Azoospermia

Eisner

Schuster

Rodgers

et al. 2004

The Annals of Family Medicine

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“…In the mouse, 23% of sperm cells are found in the vas deferens, and close to half of these are found at the middle and distal thirds of the duct [17]. In men who undergo vasectomy, sperm cells located and possibly stored in the vas deferens lumen constitute a clinical concern that induce clinicians to recommend patients to observe a period of 4 wk or several ejaculations to ensure complete clearance of sperm located at the vas deferens [18,19]. However, the literature is currently conflicting as to whether or not sperm is stored in the vas deferens or the seminal vesicles or both [18][19][20].…”

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confidence: 99%

“…In men who undergo vasectomy, sperm cells located and possibly stored in the vas deferens lumen constitute a clinical concern that induce clinicians to recommend patients to observe a period of 4 wk or several ejaculations to ensure complete clearance of sperm located at the vas deferens [18,19]. However, the literature is currently conflicting as to whether or not sperm is stored in the vas deferens or the seminal vesicles or both [18][19][20]. Therefore, it seems reasonable that as sperm cells enter or remain in the vas deferens lumen for a given period of time, they are exposed to greater bicarbonate concentrations and may undergo initiation or enhancement of the motility acquisition process.…”

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confidence: 99%

Porcine Vas Deferens Luminal pH Is Acutely Increased by Systemic Xylazine Administration1

Pierucci-Alves

Duncan

Lillich

et al. 2010

Biology of Reproduction

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Data are accumulating to demonstrate that pH regulation in the male reproductive tract has a vital role in modulating sperm cell fertilizing capacity, and therefore male fertility. Bicarbonate uptake by sperm cells is required for the achievement of motility levels required for fertilization. Vas deferens epithelial cells can carry out measurable bicarbonate secretion, but the available literature to date reports that the vas deferens luminal content is typically acidic. This study aimed to determine pH in the boar vas deferens lumen and whether modulatory mechanisms exist for regulation of pH in this compartment of the male reproductive tract. A fiberoptic pH probe was used to assess pH in the vas deferens of anesthetized adult boars. The mean pH, derived from multiple measurements at variable positions along the vas deferens lumen, was 7.39 +/- 0.09. Furthermore, administration of xylazine, an alpha-2 adrenergic receptor agonist rapidly (<10 min) alkalinized the vas deferens lumen in most cases. Because the duct was transected proximal to the site of measurements, the observations rule out the possibility that alkalinization resulted from secretion in more proximal portions of the duct. These results indicate that the boar vas deferens lumen can be alkaline, and they suggest that porcine vas deferens epithelia increase net bicarbonate secretion in vivo after systemic alpha-2 adrenergic stimulation. This secretory response greatly changes the luminal environment to which sperm cells are exposed, which will initiate or enhance motility, and is expected to modulate male fertility.

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“…More than 20% of sperm cells are found in the vas deferens, and close to half of these are found at the middle and distal thirds of its length [12]. Sperm cells stored in the vas deferens lumen, located distally from a vasectomy site, and/or seminal vesicles constitute a contraceptive concern that requires patients to observe a period of several weeks until sperm clearance is complete [29,30]. These observations demonstrate that sperm cells remain in the vas deferens lumen, exposed to its luminal composition, for much longer than is generally thought.…”

Section: Discussionmentioning

confidence: 99%

Testosterone Upregulates Anion Secretion Across Porcine Vas Deferens Epithelia In Vitro1

Pierucci-Alves

Duncan

Schultz

2009

Biology of Reproduction

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Testosterone induces and maintains prostaglandin endoperoxide synthase 2 (PTGS2, also known as cyclooxygenase 2) expression in vas deferens epithelial cells, but it remains unknown whether this has a physiological role in the context of male reproductive biology. Prostaglandins induce concentration-dependent increases in anion secretion in porcine vas deferens epithelial cell (1 degrees PVD) monolayers, where bicarbonate contributes to cAMP-stimulated anion secretion. Moreover, bradykinin induces anion secretion across 1 degrees PVD monolayers that is indomethacin sensitive, and both PTGS2 and PTGS1 are expressed in this model system. Therefore, it was hypothesized that testosterone modulates anion secretion across vas deferens epithelia via PTGS-dependent pathways and prostaglandin synthesis. Porcine vas deferens epithelial cells were isolated and cultured as monolayers on permeable supports until assayed in modified Ussing chambers. RNA and protein were isolated concurrently for semiquantitative expression analysis. Testosterone upregulated basal and bradykinin-induced short-circuit current across 1 degrees PVD monolayers, indicative of anion secretion. Testosterone also induced greater transepithelial electrical resistance. Increases in anion secretion were associated with preferential upregulation of PTGS2 at the mRNA and protein levels. In addition, testosterone induced greater basal and bradykinin-induced anion secretion across vas deferens epithelial cells isolated from the distal segment of the duct. Taken together, these results suggest that testosterone upregulates epithelial responsiveness to acute modulations of anion secretion (likely bicarbonate secretion), which ultimately modifies the environment to which sperm are exposed.

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Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? a prospective randomized trial

Cited by 30 publications

References 16 publications

A Randomized Clinical Trial of the Effect of Intraoperative Saline Perfusion on Postvasectomy Azoospermia

A Randomized Clinical Trial of the Effect of Intraoperative Saline Perfusion on Postvasectomy Azoospermia

Porcine Vas Deferens Luminal pH Is Acutely Increased by Systemic Xylazine Administration1

Testosterone Upregulates Anion Secretion Across Porcine Vas Deferens Epithelia In Vitro1

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