Ectopia of the vas deferens

Ectopic location of the vas deferens is a rare congenital abnormality that has a spectrum of presentations. Such cases have been associated with anorectal anomalies. Knowledge of distal Wolffian duct embryology may help to explain the developmental steps involved in these anomalies, as well as provide theories for the variations that may be encountered. Vas deferens development is reviewed, and two cases of vas ectopia are presented to illustrate and lend support to current theories of normal and abnormal vasal embryology.     

Physiology of the vas deferens

Summary Seminal emission occurs in response to rhythmic contractions of male secondary sex organs, including the vas deferens. Although contraction of the vas is directly due to adrenergic mechanisms, numerous substances modulate the release of norepinephrine from sympathetic pathways. These substances include local endogenous factors and neurotransmitters such as acetylcholine and NPY. Many substances are capable of altering the contractility of the vas deferens by modulating neural transmitter release or the basal tone of this smooth muscle. Because multiple pathways and substrates are capable of affecting its contractility, it is not surprising that drugs and metabolic disorders influence the function of the vas deferens and, ultimately, male fertility.     

Reconstruction of vas deferens

If the vas deferens repair operation is done in properly selected pa tients, it is possible to achieve success in 50% of cases. The method o f reconstruction used by the author is outlined and technical difficulti es are indicated. The longer the time interval between vasectomy and the repair operation, the less the chances of success. Where the interval is more than 5 years, a preliminary testicular biopsy is advised. It is better to limit the operation to patients below the age of 45 years. Care must be taken to avoid injury to blood vessels. End- to-end union of cut ends without tension must be made over an indwelling splint. The splint is removed after 6 days. When sufficient length of the vas is not available for repair without tension, a mobilization of the vas may be done similar to what is done in cases of undescended testicle. When the distal end of the vas is too short or stenosed, a vasoepididymal anastomosis may be possible. Placing a splint in these cases has been advocated also. It is better to do the operation on 1 side only. If spermatozoa are absent after 3 months, the other side may then be operated on.     

On the surgery of the vas deferens

Vasectomy is an effective measure preventing postoperative epididymectomy in prostatic and urethral surgery. The reasons why it proves sometimes ineffective are discussed. The stumps of the divided vas should be exteriorised in order to obviate complications which may arise when the stumps are burried in the scrotum. Various methods of temporary reversible occlusion of the vas were tried in prostatic patients as substitutes for vasectomy. The results of those attempts are presented. The technique of vasectomy is presented in which the stumps of the severed vas are exteriorised. Reasons for this procedure are given. Various methods were tried to produce temporary and reversible occlusion of the vas instead of vasectomy. The most promising way seems to be the ligature of the vas which is then exteriorised and wrapped with skinflap.     

Presentation of fused vas deferens

Transverse testicular ectopia is a rare condition that usually presents as a unilateral nonpalpable testis and a contralateral descended testis with an associated hernia. Currently, with the use of diagnostic laparoscopy, transverse testicular ectopia is found before groin exploration. We reviewed 2 cases that were referred to our institution. Both patients had a common vas deferens with proximal fusion. To our knowledge, a fused vas deferens has only been reported three other times in published reports. Our second case is unique in that this is the first time a common vas deferens has been reported outside of transverse testicular ectopia.     

Congenital bilateral absence of the vas deferens

A 10-year-old boy with cystic fibrosis (CF) (ΔF508/G551D mutation) underwent an uneventful elective interval laparoscopic appendectomy. During routine laparoscopic inspection of the abdomen and groins, congenital bilateral absence of the vas deferens was noted. Pictures of the patient's internal inguinal ring noted at time of laparoscopy are presented and compared with a similar-aged patient's internal ring with a normal vas deferens. The genetics of CF patients associated with congenital bilateral absence of the vas deferens is reviewed. The pediatric or general surgeon performing a herniorrhaphy should be aware of this anomaly in CF patients.     

Congenital absence of the vas deferens.

Fourteen personal cases of agenesia of the vas deferens, bilateral in 12 and unilateral in 2, are described. In 13 of the cases the diagnosis was confirmed by surgical exploration. In most of the cases cytologic examination of aspiration biopsy specimens and histologic examination of surgical specimens of the testes showed that spermatogenesis was normal. The appearance of biopsy specimens of the epididymides were normal except for a certain degree of interstitital fibrosis and dilation of the ductus epididymidis. Endeavours to produce an artificial spermatocele with the aid of an isolated flap of tunica vaginalis in several patients proved unsuccessful. In one patient with a naturally preformed spermatocele the latter was aspirated, and the patient's wife was inseminated with the cellular content from the aspirate. This procedure has been repeated on several occasions, but so far without any subsequent conception. The failure of treatment of these patients may perhaps be due to some change in the function of their epididymides. This possibility is discussed.