Unilateral absence of vas deferens: prevalence among 23,013 men seeking vasectomy

Abstract

Purpose:To determine the prevalence of unilateral absence of vas deferens (UAVD) in men with both testes seeking vasectomy.Materials and Methods:Computerized charts of 23,013 patients encountered between January 1994 and December 2013 in one university hospital and two community clinics of Quebec City, Canada, were searched. Pre-vasectomy consultation, operative reports and semen analysis results were reviewed to identify cases of UAVD. Cases were categorized as confirmed (unilateral vasectomy and success confirmed by semen analysis) or possible congenital UAVD further sub-categorized according to whether or not a scrotal anomaly was present.Results:Among 159 men identified as potentially having UAVD, chart review revealed that 47 had only one testicle, 26 had bilateral vasa, and four were misdiagnosed (post-vasectomy semen analysis [PVSA] showing motile sperm after unilateral vasectomy) leaving 82 men deemed cases of UAVD (0.36%, 95% confidence interval 0.28% to 0.43%). These were classified as confirmed (n=48, 0.21%) and possible (n=34, 0.15%; 22 without and 12 with scrotal anomalies) congenital UAVD. The misdiagnosis ratio of UAVD was low when scrotal content was otherwise normal (1:48), but higher if anomalies were present (3:12).Conclusions:Most surgeons who perform vasectomy will encounter cases of UAVD. In most suspected cases, it is safe and effective to proceed with unilateral vasectomy under local anesthesia while stressing the need for PVSA. Further studies or scrotal exploration may be considered in patient with prior scrotal surgery.

Comorbidity of the congenital absence of the vas deferens

“…CBAVD is present in 1%–2% of infertile and in 6% of azoospermic males (Dohle et al., ). The prevalence of CUAVD has been reported as 0.6% and 0.36% in some vasectomy series (Klapproth & Young, ; Miller et al., ). Some men with CUAVD may have normal fertility status and no symptoms.…”

Male partners of infertile couples with congenital unilateral absence of the vas deferens are mainly non‐azoospermic

“…Congenital unilateral absence of the vas deferens (CUAVD) is the absence of the structures originating from one Wolffian duct, mainly vas deferens (VD) with an incidence of 0.08%‐1.25% in vasectomized men . As collecting system of the kidney and seminal excretory system share the same Wolffian origin, simultaneous anomalies have been reported in series with an incidence of unilateral renal absence (URA) from 19% to 85% in men with CUAVD …”

Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential for Contraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision

“…Under these circumstances, any disturbance in the blood–testis barrier (BTB) will directly lead to ASA production [49]. Major causes for higher levels of ASA production are a vasectomy and the congenital absence of bilateral or unilateral vas deferens [50], while some minor causes for ASA production are acute or chronic epididymitis [51], trauma to the testes [52] , and cryptorchidism [53]. Detection of active spermatogenesis is a prerequisite for the diagnosis of fertile and infertile men [54].…”

“…During salpingitis, genital tract infections are found to be an important factor causing inflammation in the fallopian tubes [72]. The mechanism underlying ASA generation during salpingitis remains unclear [50]. ASAs of local and systemic origins were found in the female reproductive tract [67,69].…”