Analysis of Arterial Vasculature Present in Vasectomy Specimens: Utility of Histologic Examination
Abhishek P Patel, Gregory J Lowe, Debra L Zynger. Ohio State University Medical Center, Columbus, OH
Background: Vasectomy is one of the most common procedures performed worldwide for permanent male sterilization. The testicular, deferential, and cremasteric arteries and their branches surround the vas deferens, leaving them susceptible to injury during vasectomy. Rare procedural complications with significant morbidity include subtotal testicular infarction and testicular necrosis. There is a lack of literature describing the caliber of arteries seen in vasectomy specimens, making it difficult to categorize the significance of an observed artery. We aimed to establish reference arterial size typically encountered in vasectomy specimens.
Design: For the study, consecutively submitted vas deferens specimens from July 2011 to January 2012 at The Ohio State University were identified. The luminal diameter of the largest artery in each specimen was microscopically measured. For comparison, the diameter of the largest artery within spermatic cord cross-sections from inguinal orchiectomies were measured.
Results: We identified 231 vas deferens specimens from 116 patients (1 patient had a unilateral vasectomy). Specimens were submitted by 9 urologists, with the majority from 4 surgeons. The percentage of specimens with luminal diameter of the largest artery in the following quartiles were: 0.01-0.42 mm = 71.0%, 0.43-0.85 mm = 23.4%, 0.86-1.19 mm = 2.2%, ≥1.20 mm = 3.5% (mean = 0.03 mm, median = 0.03 mm, range = 0.01-1.7 mm). Chart review failed to reveal any intra or post-procedural complications for cases in the third and fourth quartiles. There was 1 vasectomy specimen without the presence of vas deferens (rate of vasectomy failure = 0.4%). For the spermatic cord specimens, the luminal diameter of the largest artery ranged from 3.0-4.1 mm (n = 7).
Conclusions: The arterial size routinely encountered in a vasectomy specimen was ≤1.0 mm in 96.5% of cases. Artery sizes greater than 3 mm were only seen in spermatic cord resections. Although the expert opinion statement by the American Urological Association states that histologic confirmation of the vasectomy specimens is not required, histologic submission does identify failure to transect the vas and may additionally allow identification of transection of the surrounding vasculature. These findings may provide feedback to improve surgical quality and in rare cases may be clinically relevant.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 171, Wednesday Afternoon