Ultrastructural changes in rat epididymis after vasectomy

Cellular responses to vasectomy

A number of cell populations in the reproductive tract show a response to vasectomy. Some cell types show similar responses in man and all laboratory species, whereas others show marked species variations. This chapter describes these effects in a broadly chronological order and, in a general way, considers changes close to the site of vasectomy first and the longer term effects on the testis itself later. Following vasectomy, epididymal distension and sperm granuloma formation result from raised intraluminal pressure. The sperm granuloma is a dynamic structure and a site of much spermatozoal phagocytosis by its macrophage population. In many species, spermatozoa in the obstructed ducts are destroyed by intraluminal macrophages, and degradation products, rather than whole sperm, are absorbed by the epididymal epithelium. Humoral immunity against spermatozoal antigens following vasectomy is well established and there is evidence of modest T-lymphocyte activity. The role of lymphocytes in the reproductive tract epithelium and interstitium following vasectomy is poorly defined. In laboratory animals, there is evidence that pressure-mediated damage to the seminiferous epithelium can follow sperm granuloma formation and obstruction in the epididymal head. However, the contribution of lymphocytes and antisperm antibodies to testicular damage after vasectomy is far from clear. A number of studies have suggested that testicular changes may follow vasectomy in man but their validity and mechanism of occurrence require further study.

Effects of vasectomy on the epididymis

Common principles can be discerned in the response of the epididymis to vasectomy, despite species differences. Increases in the size and number of lysosomes are the most frequent changes in the epididymal epithelium. The presence or absence of additional alterations such as changes in the height of the epithelium may be related to variations in distensibility of the vas deferens and epididymis. Direct measurements by micropuncture of epididymal and seminiferous tubule hydrostatic pressure indicate that, contrary to dogma, increased pressure in the distal epididymis after vasectomy is not generally transmitted to the seminiferous tubules. The epididymal interstitium shows microscopic changes indicative of chronic inflammation, with infiltration of macrophages, lymphocytes, and plasma cells, and rats with these lesions have higher antisperm antibody levels than animals lacking epididymal changes. Macrophages and neutrophils may enter the duct through the epididymal epithelium, at sites of rupture of the duct, and in the efferent ductules. Cyst-like spermatic granulomas occur in virtually all species where the epididymis or vas deferens ruptures with escape of spermatozoa. The sites and timing of granuloma formation may depend on the mechanical properties of the tract in different species, and they are probably important in the immune response to vasectomy. Postvasectomy sera in Lewis rats recognize a consensus repertoire of dominant autoantigens that closely resembles the antigens bound by sera from rats immunized with isologous spermatozoa. There are multiple routes for disposal of the sperm that continue to be produced after vasectomy.

Ultrastructure of epididymal interstitial reactions following vasectomy and vasovasostomy

The response of the male reproductive tract to vasectomy includes inflammation of the interstitial tissue of the epididymis. The pathogenesis of epididymal interstitial reactions and characteristics of the responding cells were studied by electron microscopy in Lewis rats at intervals following bilateral vasectomy, vasectomy followed 1 month later by vasovasostomy, or sham operations. In areas of interstitial reaction, numerous macrophages, monocytes, lymphocytes, neutrophils, and plasma cells occupied the connective tissue. Macrophages, containing many lysosomes and vesicles, aggregated and assumed the appearance of epithelioid cells. Processes of adjacent macrophages interdigitated with one another and closely approached the surfaces of lymphocytes. Many plasma cells with distended rough endoplasmic reticulum appeared in the interstitium. The majority of animals in the vasectomy and vasovasostomy groups exhibited epididymal interstitial changes by 2-3 months; the cauda epididymidis was the region most often affected. The ultrastructural features were indicative of chronic granulomatous inflammation and were consistent with an immune response that includes antigen presentation by macrophages to lymphocytes, lymphocyte differentiation, and local antibody production by plasma cells. The nearly complete absence of sperm or recognizable parts thereof in the interstitial tissue in the areas of the reactions suggests that these lesions formed in response to soluble antigens leaking from the duct. Vasovasostomy was not effective in reversing or retarding epididymal inflammation at the intervals studied.

Regional differences in the morphology of the goat epididymis: a light microscopic and ultrastructural study

The goat epididymis, based on morphological differences, was divided into five regions; regions I and II, and the proximal part of region III constituted the head; the distal part of region III and region IV, the body; and region V, the tail. The epithelium of all regions contained principal and basal epithelial cells and intraepithelial lymphocytes and macrophages. In addition, regions II to IV also contained a few apical cells. Clear cells were absent. The epithelium varied in height from the tallest in region I (88 +/- 33 microns) to the shortest in region V (38 +/- 5 microns). Conversely, the luminal diameter, thickness of smooth muscle wall, and luminal sperm concentration were highest in region V. The irregular epithelial height of regions I and IV accounted for a stellate lumen in contrast to the oval lumen of the other regions. Whereas the lumen of region I contained only a few sperm, those of regions II, III, and IV were filled with sperm. Principal cells were the only cell type that showed striking cytological differences between regions. While they contained absorptive features (canaliculi, pinocytotic and coated vesicles, and subapical vacuoles) in all regions, the principal cells of region II were filled with large, heterogeneous vacuoles (up to 5 microns in diameter), suggesting that they may be preferentially involved in transporting and digesting particulate material. Besides absorptive features, principal cells of all regions contained morphological correlates of protein synthesis such as highly developed Golgi complexes in the supranuclear area and numerous cisternae of RER near the Golgi body and in the infranuclear cytoplasm. The cisternae of RER were more developed in region IV, and in some instances, they were distended with flocculent material resembling newly synthesized protein. Unlike the protein synthesizing organelles, principal cells of all regions lacked morphological correlates of steroid hormone synthesis. These results are compared with previously published data on the regional differences in the epididymis of other species, especially with those of the rat and the bull, in an effort to understand the significance of the epididymis in sperm maturation.

Microrecanalization after vasectomy in man

Previously spermatozoa in the semen of vasectomized men were reported in 62 of 63 specimens from 24 men 2 to 31 years postvasectomy (Freund and Couture, 1982). A morphologic basis and term, "microrecanalization," was proposed for this observation. Serial sections (5 mu at 200-mu intervals) of 40 specimens removed at vasovasostomy from 20 men (2 to 14 years postvasectomy) were examined and microcanals (small epithelial-lined channels) were demonstrated in 27 specimens from 18 men. In nine of the 27 specimens, spermatozoa or sperm heads were found within the microcanals. Microcanals occurred in smooth muscle, connective tissue and scar tissue, in each segment, testicular, central and abdominal, in the presence or absence of the vas deferens. Microcanal continuity was traced for 200 to 1140 microns by computerized image analysis. Microrecanalization is characterized by the absence of inflammation or sperm extravasation and is histologically distinct from vasitis nodes or sperm granuloma. Microrecanalization provides morphologic and physiologic bases for the protection of the testis and maintenance of spermatogenesis in man after vasectomy.

Morphology of the bovine epididymis

The epididymis of the bull was divided into six regions, and morphological differences between regions were studied. The epithelium of all regions contained four cell types: principal and basal epithelial cells, and intraepithelial lymphocytes and macrophages. The epithelium of regions II-V also contained a few apical cells. Principal cells of all regions possessed an endocytotic apparatus including stereocilia underlain by canaliculi, coated vesicles, and subapical vacuoles (up to 1 micron in diameter); however, large vacuoles with a flocculent content and multivesicular bodies (up to 5 microns in diameter) were most numerous in regions II, III, and IV. The unique features of principal cells of region I were the presence of well-developed Golgi bodies, few lipid droplets, and whorls of smooth endoplasmic reticulum in the supranuclear cytoplasm. Numerous mitochondria, distended cisternae of rough endoplasmic reticulum, and dense granules characterized the infranuclear cytoplasm of the principal cells of regions II-VI; however, these features were more developed in region V. Apical cells were characterized by the apical location of the nucleus, many mitochondria in the apical cytoplasm, and few microvilli at the luminal border. Basal cells with few cytoplasmic lipid droplets were present throughout the length of the epididymis but appeared more numerous in region V. Intraepithelial lymphocytes were present at all levels of the epithelium but were never seen in the lumen. Intraepithelial macrophages containing heterogeneous granules, eccentric nuclei, and pseudopods were invariably seen near the basal area of the epithelium in all regions. These observations are discussed in an effort to define the role of each cell type in the epididymal epithelium.

Effects of long- and short-term vasectomy on structural and functional parameters of the rat

The effects of vasectomy were examined by comparing various parameters from sham operated and vasectomized rats that had undergone surgery at 90 days of age and were killed at 190 or 390 days of age. Significant alterations in the vasectomized rats from sham rats included: testicular and epididymal hypertrophy, formation of pathologic vas deferens granulomas, decreased total serum protein, lowered alpha-globulin levels as shown by serum electrophoresis, and increased sperm agglutinin antibody titers. For vasectomized rats, the differential white blood cell count showed increased numbers of neutrophils and large lymphocytes and decreased numbers of small lymphocytes and basophils. Both the number and extent of many vasectomy-induced alterations were greater in long-term vasectomized than in short-term vasectomized rats.

Morphology of the epididymal region of turkeys producing abnormal yellow semen

Male turkeys producing abnormal yellow-colored semen (YS) had hypertrophied epithelial cells in the ductuli efferentes. The cells were engorged with cytoplasmic, lipid-like (lipoid) droplets, a morphological abnormality found exclusively in this area of the epididymal region. The testes, epididymal region, ductus deferens, and abdominal fat were relatively yellow compared to turkeys producing normal white semen (WS). Adipose tissue within the abdominal cavity and lining the ductus deferens was more abundant in the YS producers. In addition to increased lipoid droplets, nonciliated cells of the ductuli epithelia contained larger and more numerous electron-dense lysosomal bodies than similar nonciliated cells in WS males. Resorption of morphologically normal and abnormal spermatozoa by the epithelia of the ductuli efferentes was prevalent in the YS males but was not observed in the WS turkeys. The seminal fluids in the epididymal region of the YS males contained abnormal spermatids, cellular debris, and increased amounts of electron-dense proteinaceous material.

The fate of sperm after vasectomy in the hamster

Young adult male hamsters were subjected to bilateral vasectomy. The reproductive tracts were studied by light and electron microscopy at intervals up to 1 year after the operation. Sperm continued to be produced, since testicular alterations were focal. Spermatic granulomas were associated with the excurrent ducts of all animals 5 months or 1 year after vasectomy and with those of one of four hamsters 2 weeks after the operation. Phagocytosis of sperm in the lumina of the efferent ducts and proximal parts of the epididymis, and disintegration of membranous components of intraluminal sperm occurred in approximately three-fourths of the animals studied 5 months or more after vasectomy. The results indicate that after vasectomy in the hamster sperm are disposed of by phagocytosis in spermatic granulomas, intraluminal phagocytosis, and dissolution in the lumen of the male ducts, although the latter process may be incomplete.

Primates: Their use in research on vasectomy

Studies based on experimental vasectomies clearly reveal marked species differences in response to vasectomy. In rats, vasectomy invariably results in granuloma formation at the surgical site. In rabbits, immune-complex orchitis develops. Allergic orchitis may also develop in guinea pigs, and the morphological lesions can be adoptively transferred. My co-workers and I have been able to study systematically, biochemically, hormonally, pathologically, and immunologically, primates vasectomized up to 14 years earlier and to compare them with age-matched controls. We have monitored antibody levels in vasectomized rhesus and cynomolgus macaques by sperm-agglutination, sperm-immobilization, and indirect immunofluorescence techniques. Antibodies develop in almost every monkey, in some as early as 10 days after vasectomy. About 50% retain such circulating antisperm antibodies. In men, antibody development is less rapid, and about half of vasectomized men reveal detectable levels. Testicular histopathological studies have revealed detectable levels. Testicular histopathological studies have revealed orchitis, aspermatogenesis, or both, resembling allergic orchitis in most of the vasectomized monkeys and in about one-fourth of the controls. Limited studies of human material reveal some testicular changes. Epididymitis and epididymal granuloma occur exclusively in the vasectomized animals. Use of immunofluorescence has revealed significantly more granular deposits of IgA, IgG, and/or C3 in the basal lamina of the ductus efferens and the caput epididymidis of the vasectomized monkeys. Similar studies on human material have not been done. Both cynomolgus and rhesus macaques have proved to be excellent models for research in atherosclerosis and so have been used to determine whether constant sperm antigen leakage causes immune-complex formation that might result in arteritis and atherosclerosis. Evaluation of the cardiovascular systems from such animals has revealed that vasectomized monkeys have more frequent, more extensive, and more severe arteriosclerosis than age-matched controls. Epidemiological studies are currently under way to determine whether such an effect also occurs in men after vasectomy.

Fine structural studies of the rat vas deferens

A fine structural study of the normal rat vas deferens was undertaken utilizing perfusion fixation. Morphological features not previously appreciated were revealed using this technique of fixation, and included the following. The rat vas deferens exhibited a gross morphological and microscopic differentiation along its length: A proximal segment was characterized by a thin muscular wall, an epithelium of low height (comparable to that of the cauda epididymidis) and a distended lumen typically filled with an accumulation of sperm; a distal segment exhibited a thick muscular wall, a convoluted mucosa, and a pseudostratified columnar epithelium with long stereocilia extending into the lumen. The transition from the morphology typical of the proximal segment to that of the distal segment was gradual and progressive, marked by an increase in the mass of the muscular wall and in the height and ultrastructural complexity of the epithelium. Clear or "foamy" cells, characteristic of the cauda epididymidis, were observed in the initial centimeter of the vas deferens. Also, a cell type designated as "mitochondrion-rich" was observed in the distal vas segment. The structure of the small mitochondria in such cells, however, did not conform to the description of mitochondria in similar cells found in the human (Hoffer, '76). Intraepithelial macrophages containing residual accumulations which often resembled spermatozoan remnants in advanced stages of dissolution were present in all segments of the rat vas deferens, confirming in this species a spermiophagic role for such cells.

Phagocytosis of spermatozoa in the terminal region and gland of the vas deferens of the rat

The existence of a discrete group of cells that are able to phagocytose spermatozoa is reported in the terminal vas deferens of the rat. In addition it is shown that phagocytosis of spermatozoa occurs in the gland of the vas deferens. The cytological mechanisms involved in the phagocytotic process are discussed, and the role that this activity may have on the removal of surplus spermatozoa is discussed.

Immunological and morphological effects of vasectomy in the rabbit

Half of the rabbits developed antisperm antibodies (measured by either indirect immunofluorescence or sperm immobilization tests) after either a unilateral or bilateral vasectomy. The raised antibody levels, particularly six months or longer after vasectomy, often accompanied patchy orchitis. Seminiferous tubules from such animals exhibited sloughed, multinucleated, and immature germinal cells which were engulfed by phagocytic cells. Mononuclear infiltrates were occasionally present. The basal lamina infolded and thickened by means of supernumerary layers and appeared to be endocytosed by cells of the seminiferous tubules. Four months after vasectomy, numerous phagocytic cells were seen in migrate through the intact epithelium of zone 1 in the caput epididymidis, and were particularly prevalent in animals that exhibited testicular damage. These macrophages may serve to present sperm antigens to lymphocytes.