Spermatogenesis in Men Treated with Injections of Medroxyprogesterone Acetate Combined with Testosterone Enanthate

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dergone ureterosigmoidostomy. Most patients studied underwent urinary diversion for benign disease, predominantly bladder exstrophy or epispadias. Other conditions were tuberculosis, incontinence, urethral stricture and malignancy. During screening fibersigmoidoscopy of these 34 patients 6 (17.6 per cent) were found to have adenomas of the left colon or severe dysplasia of the stoma, a mean interval of 22 years after the urinary diversion had been done. Four other patients had undergone surgical excision of neoplasms at the ureterocolic anastomosis. Therefore, 29 per cent of the patients studied had neoplastic lesion, almost all closely related to the stomas. Almost all patients studied were asymptomatic. Only 2 patients who were found to have adenomas had complaints of abdominal pain and rectal bleeding. This study reveals that regular screening of patients who had undergone urinary diversion by the use of fibersigmoidoscopy is important to detect and excise potentially malignant lesions. The intestinal mucosa exposed to urine may provide a unique model for the study of colon carcinogenesis. F. T. A. 1 figure, 4 tables, 15 references

SURGICAL TECHNIQUES, EQUIPMENT AND INSTRUMENTS Lymphography, a New Technique of Incision C. PARK, C. H. BAHNG AND E. C. JENNINGS, Department of Diagnostic Radiation, Roswell Park Memorial Institute, Buffalo, New York, and the Department of Diagnostic Radiology, Wilson Memorial Hospital, Sidney, Ohio

H.

J. Surg. Oncol., 20: 231-232 (Aug.) 1982 The authors present an improved technique of exposing lymph vessels before cannulation for lymphography. The technique consists of identifying the line oflymph vessels by injecting 0.2 Inl. blue contrast medium between the great and second toe. The lymphatic vessel is identified as a blue line. A 7 to 10 mm. longitudinal incision is made over the blue line between the navicular and the anterior margin of the tibiotarsal joint and the subcutaneous tissues were incised in the line of skin incision. The lymphatic vessel is isolated. The authors claim several advantages for this method. First, the selection of the vessel at the mentioned site reveals lymphatics of adequate caliber. Second, when a longitudinal incision is made recoiling of skin edges will not shut down and shorten the exposed vessel. Finally, the incision is clean, and is through skin and subcutaneous tissues without any blunt dissection, which ensures fast healing. N. V. R. 1 figure, 7 references

ANDROLOGY Who Asks for Vasectomy Reversal and Why G.

HOWARD,

Charing Cross Hospital, London, England

Brit. Med. J., 285: 490-492 (Aug. 14) 1982 In the United Kingdom no detailed accounts of the reasons for reversal of vasectomy appear to have been published. Therefore, the author interviewed 76 men requesting a reversal vasectomy between June 1978 and September 1981. Thirty-one of these men were still married. These men had decided to have a vasectomy during a crisis, such as a recent pregnancy or financial stress. Most wanted

another child but others wished to be put back to normal, and a few had hoped that reversal would help their marriage. Fortyfive (59 per cent) were divorced or separated and thought that they were disadvantaged in courtship or remarriage by being infertile, many wives or partners being desperate for a pregnancy. A greater number of requests for reversal came from men who had been <35 years old when the vasectomy had been done and were more likely to have been divorced, especially if there had been a teenage pregnancy. The risks of regret after sterilization appear to relate to immaturity at the time of the vasectomy and to be as great for young men as for young women. W. W. K. 5 figures, 1 table, 17 references

Relation Between Sperm Count and Semen Volume, and Pregnancies Obtained During Twenty-Year Follow-Up Period BosTOFTE, J. SERUP AND H. REBBE, The Sperm Analysis Laboratory, Health Services Physicians Organization, Copenhagen, Denmark

E.

Int. J. Androl., 5: 267-275 (June) 1982 The 1,077 men seen for infertility between 1950 and 1952 form the basis of this study. The patients were contacted 20 years later by questionnaire and 785 (72.9 per cent) responded. Of 53 men with sperm counts <5 million per Inl. 22.6 per cent eventually fathered living children. This finding compares to 52.2 to 63.1 per cent living children of 730 men with sperm counts >5 million per ml. Thus, the authors conclude that 5 million per Inl. is the sperm density below which fertility is significantly impaired. They found no correlation between sperm count and the number of abortions or pathological pregnancies. They also found that semen volume did not correlate with fertility. D.K.M. 4 tables, 23 references

Spermatogenesis in Men Treated With Injections of Medroxyprogesterone Acetate Combined With Testosterone Enanthate G. KuNIT, H. Joos AND R. K6HLE, Urological Department, General Hospital, Salzburg, Austria

J. FRICK, CH. DANNER,

Int. J. Androl., 5: 246-252 (June) 1982 Medroxyprogesterone acetate and testosterone enanthate were delivered in 2 different dosage schedules to 2 groups of men (4 and 5 men). In 1 group there was an initial high dose injection, followed by a monthly maintenance dose, while in the second group there was a biweekly maintenance dose after the initial high dose injection. Although complete spermatogenic arrest occurred in all 9 subjects spermatogenesis recurred during treatment in some of the subjects in each group. Full restoration of spermatogenesis occurred after treatment was discontinued but this took up to 5 months after cessation of therapy. There were no significant changes in serum or urinary hormonal concentrations and none of the subjects experienced any decrease in libido or change in sexual behavior. The authors conclude that the treatment protocols studied are inadequate for long-term male contraception. D. K. M. 4 figures, 8 references