Zusammenfassung Vas deferens‐Aplasie: Klinische und anatomische Merkmale bei 90 Fällen Von 531 Patienten mit Verschlußazoospermie ergab die Hodenfreilegung zur Epididymo‐Vasostomie eine Duktusaplasie bei 90 von ihnen (= 17%). In letzterer Gruppe wurde in 64 Fällen eine komplette beidseitige Agenesie und bei den übrigen eine teilweise Duktusaplasie oder verschiedene Befunde beider Seiten festgestellt. Die anatomischen Befunde wurden in unterschiedliche Häufigkeitsgruppen klassifiziert. Das typische anatomische Bild beinhaltete teils ausgedehnte paraepididymale Fettkörper, venöse Konglomerate an Stelle fehlender Nebenhodenanteile sowie häufig Morgagni's Hydatiden und Spermatocelen. Die präoperative Palpation und der chirurgische Befund korrelierten nicht. Laboruntersuchungen des Ejakulates zeigten bei der Mehrzahl der Fälle Volumen und Fruktosewerte unter der Norm. Die Elektronen‐ und Lichtmikroskopie ergab eine Auflösung von Spermatozoen in Spermatozoen‐Phagozytose innerhalb des dilatierten Nebenhodenkanals sowie im benachbarten Gewebe. Da die Laborwerte und die körperliche Untersuchung nicht immer einen verläßlichen Hinweis auf Duktusaplasie geben, muß die Hodenfreilegung erfolgen. Eine pelottenförmige Silikon‐Dakron Prothese wurde bei 16 Männern mit Ductusaplasie auf den Nebenhodenrest implantiert, jedoch ergaben die Inseminationen des aspirierten Materials bei deren Ehefrauen keine dauerhafte Schwangerschaft. In anderen Zentren wurden mit dieser Methode 3 Konzeptionen und normale Geburten erreicht.
A comprehensive study of major symptoms and radiological findings of 31 patients with retroperitoneal fibrosis is presented. In 6 of these cases, the disease appeared to be secondary to chronic methysergide intoxication. Major clinical signs were lumbar pain, hypertension, and renal insufficiency. Diagnosis is mainly established by IVP and retrograde pyelogram. 74% of ureteral stenoses occurred at the level of the 4th and 5th lumbar vertebrae, the remaining being more extensive. Out of 26 patients treated by ureterolysis, symptoms and ureteral stenosis reappeared in 7 cases. Of 25 surviving patients, followed postoperatively more than 2 years on an average, 20 present no further symptoms and a good renal function.
Of 30,000 men examined for impaired fertility from 1964 to the present, 900 were diagnosed as having excretory azoospermia. Of this number, 465 underwent surgery. Epididymovasostomy was performed on 316 men. For 11 years, this surgery was done with surgical loupes, and a patency rate of 48% was achieved in those men undergoing bilateral epididymovasostomy. (Only 52% of our patients showed inflammatory obstruction.) In a small series of patients undergoing the procedure under the operating microscope, a patency rate of 75% was achieved. Vasovasostomy was performed in 20 patients with loupes and splints. Patency was obtained in 11 of the 17 that were followed. Ten of 12 patients receiving anastomosis by a technique placing nonabsorbable sutures through the entire wall of the vas became fertile. Nine of 10 patients who were operated on by a double-layer technique under the operating microscope were found to have patent ducts at follow-up. The advances in microsurgical techniques, equipment, and suture materials have considerably improved the changes for refertilization.
Experimental studies in rats and bulls demonstrated the feasibility of using a silicone-Dacron prosthesis as a sperm reservoir in cases of excretory azoospermia. In the study of bulls, 50% of the cows inseminated with spermatozoa aspirated from the alloplastic spermatocele conceived and delivered healthy calves. The clinical results of a series of 14 humans suffering from excretory azoospermia not treatable by other means (e.g., epididymovasostomy or vasovasostomy) also are presented. THe aspirations from these spermatoceles produced motile spermatozoa; however, none of the patients'p spouses conceived after insemination.
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