Treatment of vas deferens large defects

Abstract

Based on the experience of 12 vas deferens reconstructions in 8 patients with iatrogenic (post-herniotomy in infancy) vasa lesions the authors conclude that in the majority of such cases the length of vas defects renders direct vasovasoanastomosis either impossible or too risky, due to tension. To solve the problem the methods of extraanatomical (sub- and suprapubic) vas rerouting were elaborated that allow to shorten the vas length necessary for anastomosing by 9–14 cm. Combined with various crossover techniques, and vasoepididymostomy if necessary, the method proved valuable in most cases of extensive mono- and bilateral vasa deferentia lesions.

The experimental data on vas segment transplantation obtained in rats show poor results in the homotransplantation group while autotransplants survive in 70% and provide vas patency restoration in 40%. No experimental proof in favour of endoprosthesing of vas grafts is obtained.