BERKELEY, CA (UroToday.com) - Vasectomy is the most common procedure performed for male sterilization worldwide, with over 500 000 men undergoing this procedure annually in the United States alone. Most complications are infrequent and can be categorized as minor (hematoma, localized infection) and resolve without long-term consequences. The critical part of a vasectomy involves identifying and cutting out a small segment of the vas deferens. Since there are vessels that supply blood to the testicle surrounding the vas deferens, it is possible to injure them. Our current project idea was conceived after we received a case in consultation in which an attempted routine vasectomy followed by an attempted repeat vasectomy resulted in testicular ischemic necrosis and loss of the testicle.
The recommended vasectomy techniques by the American Urological Association and European Association of Urology involve transecting the “bare vas,” without any surrounding vasculature. However, the submission of the vas for histologic analysis is not required. Additionally, in pathologic reporting of the vas, it is common practice to only comment on the presence of vas deferens in the specimen and not on any surrounding vasculature. If a pathologist does want to comment on the presence of perivasal vasculature, there are no guidelines to indicate what size vessel is out of the norm. As such, a surgeon may not submit the vas for histologic assessment as it is not required, and if the vas is submitted, the surgeon typically does not get any quality-control feedback regarding transected vessels.
We sought to investigate the size of the perivasal vasculature routinely encountered in vasectomy specimens. Doing so would allow us to establish a baseline for the “normal” amount of perivasal tissue seen in an otherwise uncomplicated vasectomy cohort. Therefore, pathologists reviewing the vasectomy specimens could let the surgeon know 1) if no vas is identified and 2) if a larger than expected blood vessel is encountered.
We found that arterial size routinely encountered in the histologic examination of vasectomy specimens was 1.0 mm or less in 96.5% of cases. We do not advocate measuring perivasal vessels in every case, or mentioning this in the pathology report, but a good rule of thumb is if the vessel is similar in size, or larger than the vas, it may be worth documenting, particularly for patients in which no vas is identified. This will provide the surgeon with quality-control feedback and alerts future surgeons to be more cautious during procedures that may further compromise testicular blood supply.
Abhishek P. Patel, MD, Gregory J. Lowe, MD, and Debra L. Zynger, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
The Ohio State University Medical Center, Columbus, OH USA