A case of congenital unilateral absence of the vas deferens

Abstract

BackgroundCongenital unilateral absence of the vas deferens occurs in 0.5%–1.0% of males. It has been associated with various genitourinary abnormalities, including renal agenesis. We report a case of congenital unilateral absence of the vas deferens found incidentally during vasectomy in a patient with known unilateral renal agenesis.Case presentationA 24-year-old male presented to our urology clinic requesting vasectomy. His past history was significant for left renal agenesis. Following successful right vasectomy, several attempts to locate the left vas deferens were unsuccessful. We diagnosed congenital unilateral absence of the vas deferens. Follow-up semen analysis showed azoospermia.ConclusionAs vasectomies are increasingly performed in outpatient settings, it is imperative that physicians be aware of this condition, which can be recognized by a simple physical exam. Recognition could prevent unnecessary surgery and prompt providers to investigate for associated abnormalities.

Male Genitourinary System

“…While CBAVD is most commonly associated with CFTR gene mutations (55-90%) and uncommonly associated with renal agenesis (10-11.8%), CUABD is more commonly associated with renal agenesis (19-91%) and less commonly associated with CFTR mutations (Schlegel et al 1996;Stuhrmann and Dörk 2000;McCallum et al 2001;Kolettis and Sandlow 2002;Mo et al 2013). CUAVD is also strongly associated with contralateral genitourinary anomalies such as vesicoureteral reflux, varicocele, cryptorchidism, and ureteropelvic junction obstruction (Schlegel et al 1996;Mo et al 2013). Patients with CUAVD may have a patent (67%) or obstructed (33%) contralateral vas deferens.…”

“…Men with CUAVD may present for evaluation for vasectomy or for other genitourinary complaints (Kolettis and Sandlow 2002). CUAVD is up to twice as common on the left (Weiske et al 2000;Mo et al 2013). …”

“…The diagnosis of CAVD may be based on a physical exam, although vasography or transrectal ultrasound may confirm the diagnosis (Mo et al 2013). All patients with CAVD desiring to have children should undergo CFTR mutation testing, understanding that there are more uncommon mutations not covered by routine testing and novel mutations continue to be discovered (Mak et al 1999;Sharma et al 2009).…”

“…More rarely, vesicoureteral reflux or ureterovesical obstruction in the contralateral kidney may occur. Ipsilateral agenesis of the adrenal is possible (Mo et al 2013).…”

A missing vas deferens: practical implications for urologists performing vasectomies and managing infertile men

“…Intrinsic Wolffian duct defects may result in failure of the vas deferens to develop, a condition that can occur in isolation or combined with renal agenesis or malformations. A missing vas, that is, unilateral absence of vas deferens, albeit relatively uncommon may be found by urologists performing vasectomies or evaluating men with fertility problems ( 1 , 2 ). It is, therefore, important that urologists be aware of the practical implications when finding such a case scenario.…”