Spontaneous Recanalisation of the Divided Vas Deferens

Abstract

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...

Vasectomy: How Much is Enough?

“…Vasectomy failure occurs because a sperm granuloma bridges the gap between the two ends of the vas and then subsequently recanalises (Pugh and Hanley, 1969). If a separation of the cut ends of the vas greater than the maximum reported size of a sperm granuloma (1 7 mm) (Pugh and Hanley, 1969) could be achieved, then recanalisation would be impossible. Our results (Fig.…”

“…Bilateral vasectomy is commonly performed to achieve male sterilisation for family planning (Hanley, 1968;Blandy, 1979). It is easily and safely performed under local anaesthesia and the rare failure that occurs is due to sperm granuloma formation with spontaneous recanalisation (Pugh and Hanley, 1969). There is some evidence to suggest that the length of vas removed affects the failure rate (Hanley, 1968;Kaplan and Heuther, 1975), though the exact length that should be removed is not known.…”

Vasectomy and vasectomy reversal

“…The rather cosy image sometimes Accepted for publication 28 January 1994 projected of vasectomy as a minor procedure with negligible risk has led some men to become extremely disgruntled when, for example, they developed a scrota1 haematoma as large as a grapefruit and litigation has followed, not because the haematoma occurreda complication that can occur after any operationbut because no warning was given that it might happen. Failure due to spontaneous recanalizationan event documented clearly over 20 years ago [9] has led to a successful claim for damages when it did happen because the finality with which the vasectomy was presented and the wording of the consent form were so specific that the female partner mistook her amenorrhoea for the menopause until it was too late to have the unwanted pregnancy terminated [ 101. Clear warning is therefore essential for two reasons: first, to enable the man to decide whether to have the operation or not, and second, to allow the female partner to take prompt steps to seek help if a pregnancy should unexpectedly occur [ l l ] .…”

Vasectomy and vasectomy reversal

“…Failure to mention the possibility of long-term failure due to spontaneous recanalization, an event documented clearly over 15 years [5], has certainly led to a successful claim for damages, since the finality with which the vasectomy was presented and the wording of the consent form were so specific that the wife mistook her amenorrhoea for the menopause until it was too late to have the unwanted pregnancy terminated [6]. It is evident that clear warning is essential for two reasons: firstly to enable the husband to decide whether or not to have the operation, and secondly to allow the wife to take prompt steps to seek help should a pregnancy unexpectedly occur [7].…”