(056) Cross-sectional Analysis of the Vas Deferens and Its Associated Blood Supply

Abstract

Abstract Introduction In performing both vasectomy and vasectomy reversal, a precise understanding of the local anatomy and blood supply of the vas deferens and associated structures is essential. However, the exact importance and contribution of the perivasal versus intramural vessels in perfusion to the vas deferens has not been investigated. This may be clinically relevant as the perivasal blood supply may be prone to compromise with bipolar electrocautery during the vasectomy reversal, potentially resulting in a poor blood supply to the anastomosis which can detrimentally affect outcomes. Objective To highlight the importance and contributions of the perivasal and intramural vessels in the blood supply to the vas deferens Methods 92 consecutive bilateral vas deferens specimens from 46 patients undergoing first time vasectomy were examined. H&E slides were reviewed by a senior genitourinary pathologist to describe architectural and growth pattern of the small arteries. Intramural (arterioles in the muscular coat of a vas deferens) and perivasal (those located in the vas adventitia immediately juxtaposed to the organ) arterioles were counted microscopically. Clinical data, including patient age and ethnicity, were obtained by reviewing medical charts. Results The average number of perivasal arteries surrounding the bilateral vas deferens in each patient was 15 ± 4 whereas the number of intramural arteries was 4.5 ± 3. There was no linear trend between the age of our patients or the number of intramural or perivasal arteries. Five patients (11%) had less than 2 total intramural arteries. Conclusions Our study found significantly more perivasal arteries than intramural arteries in vas deferens samples. Interestingly, this association did not seen to vary with patient age. To our knowledge, this represents the first study to demonstrate this anatomical relationship and suggests there may be greater reliance on perivasal arteries for overall vas deferens perfusion, thus emphasizing the importance of prioritizing the preservation of the perivasal blood supply during vasectomy. This may be particularly relevant should a future reversal be considered. Future directions may include examining specimens of patients undergoing vasectomy reversal and evaluating the relevant vasculature and procedure outcome/success. Disclosure No.