ALLOPLASTIC SPERMATOCELE Insemination from Epididymal Reservoir

Insemination with the sperm of an epididymal reservoir three days after implantation of the prosthesis led to a successful pregnancy with subsequent delivery of five healthy sucklings. Alloplastic spermutocele can function longer than four months as proved by a successful pregnancy. An alloplastic spermatocele is a silicone reservoir which can be sutured onto the caput or cauda epididymis (Fig. 1). In cases of longstanding stenosis or aplasia of vas deferens this spermatocele can function as a reservoir. Further indications for an alloplastic spermatocele can be unsuccessful reanastomoses of vas deferens alter vasoresection, obstruction of ejaculatory ducts, and loss of ejaculation. On the day of ovulation of the female the prosthesis can be punctured, irrigated, aspirated, and the partner inseminated with the aspirate. Schoysman’ was the first to use saphenous veins as a reservoir. Since they collapse easily, he later used tunica vaginalis with a silicone spiral to prevent collapse.’ FIGURE 1. KeEmi-Affeld prosthesis: reservoir connected with nonkinking tubing system with irrigation-aspiration button. Inner surface of reservoir margin is covered with Dacron velour. We started experimenting in September, 1973. The first series on rats was unsuccessful.3 We changed over to minipigs and developed the prosthesis in its present form.4-6 We proved that a reservoir could function fully even after four months we used the aspirated sperm for insemination successfully and an inseminated female minipig could deliver healthy sucklings. At the same time Wagenknecht et al. ‘+I used a similar prosthesis on 30 rats and 6 bulls with insemination and subsequent pregnancies in 2 of 4 bulls. Material and Methods On 16 minipigs 22 prostheses were implanted in the caput region and on 24 minipigs 47 prostheses in the cauda region, totaling 69 prostheses on 40 minipigs (Figs. 1 to 4). The prosthesis is made of one piece and consists of three parts: (1) a reservoir with a volume of 1.5 ml. ; the inner surface of the margin is made of Dacron felt; (2) a connecting tube with a metal spiral in the wall in future models to prevent kinking; and (3) irrigation-aspiration button with a self-sealing membrane. The button is laid subcutaneously into the lower part of the abdomen and punctured with a UROLOGY ! OCTOBER 1977 / VOLUME X, NUMBER 4 317 FIGURE 2. (A and B) Cauda epididymis of minipig is incised and reservoir anastomosed with 5-O monofilament suture material with tunica albuginea of epididymis. FIGURE 3. (A) Prosthesis on caput region of epididymis. (B) Irrigation-aspiration is perfn-med with 14-gauge needle; anastomosis terminated. (C) Tunica vaginalis closed. 14gauge needle under sterile conditions, irrigated with tris-buffer solution, and the contents of the reservoir aspirated. Others puncture the reservoir itself.7-Q We do not follow that procedure because of injury to the reservoir and epididymis. The insemination is performed with open surgery directly into the fallopian tubes. The prostheses are removed as soon as the production of sperm ceases. The reservoirs were irrigated and aspirated at different times such as daily, every other day, every third day, weekly, and monthly. The largest amount of sperm (600 million to 1.2 milliards) is aspirated between the third and fifth postoperative days. The motility (up to 80 per cent with 50 per cent forward movement) is the highest between the third and fifth postoperative days. The sperm count diminishes day after day and stops approximately after three to four weeks. This is because of infection and obliteration of the proximal tubule. In one case the noninfected prosthesis was not removed, and an excellent aspiration was achieved even four months after surgery which was then used for a 318 UROLOGY / OCTOBER1977 / VOLUMEX, NUMBER4