Monga M, Wang R, Roberts J A, Hellstrom W J
Tulane Regional Primate Research Center, Covington, Louisiana.
J Androl. 1994 Jul-Aug;15(4):309-10.
Repeat microscopic epididymal sperm aspiration (MESA) is used to treat congenital absence of the vas deferens (CAVD). Use of alloplastic implants as reservoirs results in poor sperm motility and pregnancy rates. An autoplastic tunica vaginalis reservoir for epididymal sperm has been used in four patients, with one resultant pregnancy. We studied this technique in a monkey model. Eight reservoirs were created in four monkeys (Cercopithecus aethiops). The vas deferens was ligated close to the epididymis. A transverse incision was made in the caput epididymis, and sperm were aspirated for analysis. Cut margins of the epididymal duct were sutured open to the visceral layer of the tunica vaginalis. The defect in the parietal layer of the tunica vaginalis was repaired, and sterile Tyrode's solution was instilled in the potential space between the parietal and visceral layers. Initial epididymal sperm obtained at the creation of the sperm reservoir demonstrated adequate mean motility (60.5%, grade 1.5), morphology (82.8% normal), and viability by Eosin-Y exclusion (69.9%). At 4 weeks, no reservoirs were palpable. Percutaneous aspiration (25-gauge angiocatheter) yielded no fluid. Surgical exposure of the reservoirs demonstrated significant adhesions and scar formation between the parietal and visceral layers of the tunica vaginalis, obliterating the potential space. No sperm were detected in irrigant fluids at this time. In conclusion, adhesion and scar formation may prevent use of the tunica vaginalis reservoir as an alternative to repeat MESA in treatment of CAVD.
重复显微附睾精子抽吸术（MESA）用于治疗先天性输精管缺如（CAVD）。使用异体植入物作为储存器会导致精子活力和妊娠率低下。一种用于附睾精子的自体阴道鞘膜储存器已应用于4例患者，其中1例成功妊娠。我们在猴子模型中研究了该技术。在4只猴子（埃塞俄比亚猕猴）身上创建了8个储存器。输精管在靠近附睾处结扎。在附睾头部做一横切口，抽吸精子进行分析。附睾管的切缘缝合开放至阴道鞘膜的脏层。阴道鞘膜壁层的缺损进行修复，无菌台氏液注入壁层和脏层之间的潜在间隙。在创建精子储存器时最初获得的附睾精子显示平均活力充足（60.5%，1.5级）、形态正常（82.8%）以及通过伊红-Y排除法检测的存活率（69.9%）。4周时，无法触及任何储存器。经皮抽吸（25号血管导管）未抽出液体。手术暴露储存器显示阴道鞘膜壁层和脏层之间有明显粘连和瘢痕形成，使潜在间隙消失。此时在冲洗液中未检测到精子。总之，粘连和瘢痕形成可能会阻碍将阴道鞘膜储存器用作重复MESA治疗CAVD的替代方法。
