Harefield and Hillingdon HospitalsDURING the past few years nearly 500 pyelogram studies have been made with the X-ray image intensifier for all conceivable types of renal pathology. A majority of these records concern patients having no disease referable to the pelvi-ureteric junction per se-so that we now feel we are beginning to know a little about the variations of the normal emptying mechanism. These studies have been correlated with the pre-operative and post-operative X-rays of a personal series of over 170 plastic operations for hydronephrosis, while some seventy hydronephroses have been examined under the intensifier before and after operation.
VOLUNTARY male sterilisation with the object of producing complete sterility without loss of potency or libido is best achieved by carefully performed bilateral vasectomy. The operation is not technically difficult, but it is perhaps not sufficiently widely appreciated that spontaneous recanalisation of the divided vasa sometimes occurs subsequently, with the return of the sperm count to normal or near normal values (O'Connor, 1948; Rolnick, 1954;Bunge, 1968). This paper reports a series of seven patients in whom the vasa recanalised after complete surgical section, in some cases combined with partial excision.Case Histories.-Seven healthy adult males had been subjected to bilateral vasectomy in order to render them sterile. In three men (Group I) a segment of vas, up to 3 or 4 cm. in length, had been excised and the cut ends tied off, and in the other four (Group 11) the vasa had merely been divided and tied. Routine post-operative examinations of ejaculates were carried out. The operation was deemed to have failed in all seven either when a patient's wife became pregnant or because sperms continued to be found in the ejaculate for longer than the three to five month period usually considered necessary to empty the vesicles (Hanley, 1968). The findings are summarised in the Table. All seven patients were re-explored (Case 1 by Mr P. Hickinbotham of Leicester General Hospital, and the remainder by H. G. H.) and segments of vas were removed from each side.Pathology.-The specimens available for pathological examination consisted of paraffinembedded material of the portions of the right and left vasa excised at the first operation in Case 1, and the lengths of vas removed at the second operation in each of the seven patients. The pieces of vas were pinned out on to sheet cork immediately after removal, care being taken to avoid placing pins through narrow segments or nodular areas. The cork was then floated, with the specimen on its underside, on the surface of a bowl of formol saline to ensure fixation without undue distortion. After adequate fixation the specimens were photographed and any narrowed or dilated or otherwise obviously abnormal areas were embedded in paraffin and sectioned serially (Cases 1, 4, 5 and 7), or by the step-section technique (Cases 2, 3 and 6). RESULTS Group I (vasectomy with resection)Case 1.-The portions of the right and left vasa excised at the first operation were of normal appearance (Fig. 1). The specimens received from the second operation are illustrated in, Figure 2. The piece of right vas measured 9.5 cm. in length and had a uniform external diameter of 0.25 cm. except in the centre, where there was an irregular expanded area 1 em. in length and up to 0.6 cm. in diameter. The piece of left vas was 8 3 cm.long and was similarly thickened in one area. Serial 5 p sections in the transverse plane were examined from the scarred areas of the vasa and several random transverse sections were taken above and below the scars. These latter sections revealed a n essentially normal appearance...
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