Br. J. Surg. Vol. 63 (1976) 464
Congenital absence of the vas deferens G. P. RUBIN A N D I . TAYLOR* SUMMARY
A case is presented of congenital absence of the left vas deferens, kidney and ureter, and the literature relating to this anomaly is reviewed.
VASECTOMY is now an extremely commonly performed procedure. This case report is intended to draw attention to the possibility of unilateral absence of the vas and ipsilateral kidney.
Case report H. G., a 35-year-old man, was admitted for repair of a right inguinal hernia. As he had 4 children he requested a vasectomy at the same time. On examination a n indirect right inguinal hernia was present. A normal right vas was palpable, but the presence of a left vas was not established with certainty. The patient denied any symptoms or history of urinary tract disease. At operation the right inguinal hernia was repaired, and a normal right vas was found. This was divided and ligated in the normal manner. The left vas could not be palpated through the scrotum. The scrotum was incised, and the testis and spermatic cord delivered. Dissection of the card revealed that the left vas was absent, and the epididqmis atrophic. Both testes were normal. A subsequent intravenous pyelogram showed an absent left kidney and ureter, with hypertrophy of the right kidney. Seminal analysis 6 weeks after operation indicated aspermia.
Discussion The case described represents unilateral congenital absence of the mesonephric duct. The embryological development of the urogenital tract is a complex matter, resulting in a relatively high incidence of congenital abnormalities. Guizzetti (191 8) estimated that anomalies of the genital tract are present in one-third of patients with renal anomalies. This frequent association is explained by the common origin of both tracts from the mesonephris duct. Absence of the mesonephric duct precludes formation of the ureteric bud, and results in renal agenesis and absence of the ipsilateral vas deferens. The literature contains several reports covering a wide range of anomalies involving the vasa deferentia, usually based on surveys of patients with fibrocystic
464
disease, or the sub-fertile, amongst whom they are more common. Complete absence of a vas deferens and the ipsilateral renal tract is, however, a rare occurrence (Priesel, 1924). Four cases were seen in the Ochsner clinic between 1965 and 1972 (Ochsner et al., 1972). In a series of 12000 infertile patients Charney and Gillenwater (1965) found 37 with an absent vas, of whom 2 had ipsilateral renal agenesis. It is noteworthy that in all the cases so far described the anomaly has occurred on the left (Hutch, 1972; Ochsner et a]., 1972). There does not, however, appear to be any obvious embryological basis for this finding. The increased popularity of vasectomy may well make the absent vas a more common finding. The importance of preoperative examination and palpation of the vasa is stressed. As the present case demonstrates, with an absent vas the possibility of associated renal anomalies exists, and further investigation of the renal tract is always indicated. Acknowledgement We would like to thank Mr C. H. Talbot for allowing us to present this case report of a patient admitted under his care. References and GILLENWATER J. Y. (1965) Congenital absence of the vas deferens. J. Urol. 93, 399401. GUIZZETTI P. (1918) Genital anomalies as a clue to renal anomalies. Riforma Med. 34, 646. HUTCH J. A. (1972) Anomalies of the vas deferens. JAMA 291, 1762-1763. OCHSNER M. G., BRANNAN w. and GOODIER E. H. (1972) Absent vas deferens associated with renal agenesis. J A M A 222, 1055-1056. PRIESEL A. (1924) uber das Verhalten von Hoden und Nebenhoden bei angeborenem Fehlen des Ductus Deferens. Virchows Arch. Pathol. Anat. 249, 246-304. CHARNEY c . w .
* Department of Surgery, Royal Infirmary, Sheffield.
Congenital absence of the vas deferens G. P. RUBIN A N D I . TAYLOR* SUMMARY
A case is presented of congenital absence of the left vas deferens, kidney and ureter, and the literature relating to this anomaly is reviewed.
VASECTOMY is now an extremely commonly performed procedure. This case report is intended to draw attention to the possibility of unilateral absence of the vas and ipsilateral kidney.
Case report H. G., a 35-year-old man, was admitted for repair of a right inguinal hernia. As he had 4 children he requested a vasectomy at the same time. On examination a n indirect right inguinal hernia was present. A normal right vas was palpable, but the presence of a left vas was not established with certainty. The patient denied any symptoms or history of urinary tract disease. At operation the right inguinal hernia was repaired, and a normal right vas was found. This was divided and ligated in the normal manner. The left vas could not be palpated through the scrotum. The scrotum was incised, and the testis and spermatic cord delivered. Dissection of the card revealed that the left vas was absent, and the epididqmis atrophic. Both testes were normal. A subsequent intravenous pyelogram showed an absent left kidney and ureter, with hypertrophy of the right kidney. Seminal analysis 6 weeks after operation indicated aspermia.
Discussion The case described represents unilateral congenital absence of the mesonephric duct. The embryological development of the urogenital tract is a complex matter, resulting in a relatively high incidence of congenital abnormalities. Guizzetti (191 8) estimated that anomalies of the genital tract are present in one-third of patients with renal anomalies. This frequent association is explained by the common origin of both tracts from the mesonephris duct. Absence of the mesonephric duct precludes formation of the ureteric bud, and results in renal agenesis and absence of the ipsilateral vas deferens. The literature contains several reports covering a wide range of anomalies involving the vasa deferentia, usually based on surveys of patients with fibrocystic
464
disease, or the sub-fertile, amongst whom they are more common. Complete absence of a vas deferens and the ipsilateral renal tract is, however, a rare occurrence (Priesel, 1924). Four cases were seen in the Ochsner clinic between 1965 and 1972 (Ochsner et al., 1972). In a series of 12000 infertile patients Charney and Gillenwater (1965) found 37 with an absent vas, of whom 2 had ipsilateral renal agenesis. It is noteworthy that in all the cases so far described the anomaly has occurred on the left (Hutch, 1972; Ochsner et a]., 1972). There does not, however, appear to be any obvious embryological basis for this finding. The increased popularity of vasectomy may well make the absent vas a more common finding. The importance of preoperative examination and palpation of the vasa is stressed. As the present case demonstrates, with an absent vas the possibility of associated renal anomalies exists, and further investigation of the renal tract is always indicated. Acknowledgement We would like to thank Mr C. H. Talbot for allowing us to present this case report of a patient admitted under his care. References and GILLENWATER J. Y. (1965) Congenital absence of the vas deferens. J. Urol. 93, 399401. GUIZZETTI P. (1918) Genital anomalies as a clue to renal anomalies. Riforma Med. 34, 646. HUTCH J. A. (1972) Anomalies of the vas deferens. JAMA 291, 1762-1763. OCHSNER M. G., BRANNAN w. and GOODIER E. H. (1972) Absent vas deferens associated with renal agenesis. J A M A 222, 1055-1056. PRIESEL A. (1924) uber das Verhalten von Hoden und Nebenhoden bei angeborenem Fehlen des Ductus Deferens. Virchows Arch. Pathol. Anat. 249, 246-304. CHARNEY c . w .
* Department of Surgery, Royal Infirmary, Sheffield.
