DOUBLE CONJOINING VAS DEFERENS ROY G. GRAVESEN, M.D. From the Department of Family Medicine, University of California, Irvine, California
A B S T R A C T - - The importance o f careful palpation o f the scrotal contents and follow-up semen analysis when performing vasectomies is proved by this case report o f a double vas deferens conjoining into a single vas.
Congenital anomalies of the vas deferens are uncommon; the anomaly seen most frequently is the congenital absence of one or both vasa. This is essentially the rule in males with cystic fibrosis and occurs occasionally with ipsilateral renal agenesis and other anomalies of the urinary tract. I n t e r e s t i n g l y , the vas d e v e l o p s embryologically from the mesonephric duct as does the ureter and kidney; the testis develops from the genital ridge. This explains the usual finding of a normal testis with an absent vas. Herein is reported a case of double vasa from the epididymis conjoining into a single vas without any other genitourinary abnormalities. Case Report A forty-two-year-old father of six requested sterilization. Bilateral vasectomy was performed as an office procedure under local anesthesia (lidocaine) using bilateral scrotal incisions. On e n t e r i n g the right side of the scrotum and dissecting out the vas deferens, it was found to be double and conjoining (Fig. 1). One of the conjoining branches was normal in size; the o t h e r was a b o u t o n e - h a l f t h e d i a m e t e r of normal. This had not been noted during palpation. The Y formed by this anomaly was excised, and all three ends were ligated. The left vas was single and the diameter of the smaller branch on the right. Extensive palpation and exploration did not reveal another vas. Semen analysis fourteen weeks later showed no sperm. Results of a complete physical examination, urinalysis, and e x c r e t o r y u r o g r a p h y w e r e normal.
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Comment A review of the literature did not reveal any other similar case. Nowak x r e p o r t e d a patient with failure of fusion of the epididymis and testicle with comp l e t e separation of the vas d e f e r e n s . (The testicle was in the abdomen and the vas ext e n d e d into the scrotum.) Beall and Ware z reported a case of an intercommunicating vas deferens in which the vas of one side communicated directly with the contralateral vas (no seminal vesicles were present). Search of the literature shows only 9 cases of double vasa. Mathe and Dunn s and Koyangi et al. 4 reported cases of a double vas deferens associated with ipsilateral renal agenesis where the vas simulated a ureter. Alpert and Gillenwater ~ reported a case of an ectopic vas communicating with the lower ureter. Wescott and
F I G U R E 1.
Double conjoining vas deferens.
Dykhuizen 6 reported a case of an accessory vas associated with polyorchism. Saunders in 1948 found a vas leaving the epididymis as a single tube which branched distally into a double tube w h i c h o p e n e d into the ejaculatory duct. a Blecher a and Mysorekar 7 each reported a case of total double vasa. Buttner noted a double vas without duplication of the sheath. 3 Priesl reported a double seminal vesicle and vas deferens, the inner vas ending blindly. 3 Community Clinic of Orange County 2000 West Walnut Street Santa Ana, California 92703
~e fe reFicf~s 1. Nowak K: Failure of fusion of the epididymis and testicle with complete separation of the vas deferens, J. Pediatr. Surg. 7:715 (1976). 2. Beall ME, and Ware RE: Intercommunicating vas deferens, J. Urol. 116:126 (1976). 3. Mathe CP, and D u n n G: Double vas deferens associated with solitary kidney, ibid. 59:461 (1948). 4. Koyangi T, Tsuji I, Ishikawa T, and Sasaki K: Double vas deferens associated with ipsilateral renal agenesis simulatory ectopic ureter, ibid. 108:631 (1972). 5. Alpert HJ, and Gillenwater JY: Ectopic vas deferens communicating with lower ureter: embryological considerations, ibid. 108:172 (1972). 6. Wescott JW, and Dykhuizen RF: Polyorchisrn, ibid. 98: 497 (1967). 7. Mysorekar VR: Accessory vas deferens: a case report, Br. J. Urol. 44:339 (1972).
UROLOGY / MARCH 1980 / VOLUME XV, NUMBER 3