[Sperm granulomata]

Abstract

Sperm granulomata are rare without prior surgical intervention but constitute a common complication of vasectomy and affect 35 and 42% with the conventional methods. Refertilizing and sperm quality are better in cases of sperm granulomata and, as opposed to previous assumptions, reduced fertility is not found in cases of sperm granulomata in patients with sperm antibodies. Fewer complaints are observed after open end vasectomy despite the particularly high incidence of sperm granulomata. Unfortunately, the literature does not appear to contain randomized investigations as guidelines for the choice of surgical method for vasectomy.

PIP: Sperm granulomata are frequent complication of bilateral vasectomy ranging between 35% and 42% in case of conventional ligation. New investigations have hinted at the beneficial effect of refertilization. 9000 vasectomies and 200-300 refertilizations are performed annually in Denmark. Granulomas are knot like tumors localized in the testis, epididymis, or ductus deferens and usually measure 3-7 mm. The earliest changes appear 4 days after vasectomy, and the fully developed granuloma appears after 208 days. Clinical symptoms can include pain radiating to the groin imitating kidney spasms. The pains are usually of modest intensity but can last from months to a year. Almost half of them granulomas are without symptoms. Their incidence after vasectomy ranges between 5% and 97% depending on the type of surgery; they occur most often after open ended vasectomy and least often after electrocoagulation. Finding a sperm granuloma at the testicular duct end means less dilatation, and such a patient with good sperm quality has normal fertility after vasovasostomy. Between 34% and 73% of vasectomized men develop sperm antibodies. The development of sperm antibodies did not affect fertility. It seems that refertilization is easier in the presence of sperm granuloma, and likewise sperm quality is the best if there has been a sperm granuloma. However, this is contrasted with the fact that out of 9000 vasectomized patients barely 3% regretted it. Antibodies developing after vasectomy do not have a definite relationship to sperm granulomata, and did not affect the conception rate after a well-executed vasovasostomy.