Vas deferens aplasia: clinical and anatomical features of 90 cases.

Abstract

Out of 531 patients with excretory azoospermia, scrotal exploration for attempted epididymo-vasostomy showed vas aplasia in 90 of them (= 17%). In the latter group complete bilateral agenesis of the vas was seen in 64 cases while the remaining showed partial vas aplasia or different findings on both sides. The anatomical findings were classified into various groups of frequency. The typical peroperative picture included extensive paraepididymal bodies of fat, venous conglomerations at the place of missing epididymal structures and frequent Morgagni's hydatides and spermatoceles. Preoperative palpation and surgical findings did not correlate. Laboratory examination of the ejaculate showed volume and fructose values below the norm in the majority of cases. Electron- and light-microscopy showed dissolution of spermatozoa and sperm-phagocytosis within the dilated epididymal canal as well as within the bordering tissue. Since laboratory- and physical examinations are misleading in some cases with vas aplasia surgical exploration is necessary. A cup-shaped Silicone-Dacron reservoir was implanted upon the remaining epididymal structures in 16 men with vas aplasia, but insemination of the aspirated material in their wives did not lead to any lasting pregnancy. In other centers 3 conceptions and normal births were obtained by this method.