先天性雙側無輸精管併雙側正常儲精囊－罕見病例報告

張顥瀚13, 溫聖辰13, 李經家123

高雄醫學大學附設中和醫院 泌尿部1、高雄醫學大學醫學系 泌尿學科2、高雄醫學大學 臨床醫學研究所３

Congenital bilateral absence of the vas deferens (CBAVD) with bilaterally present seminal vesicles

Hao-Han Chang13, Shen-Chen Wen13, Ching-Chia Li123

1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

2Department of Urology, School of Medicine, College of Medicine, KaohsiungMedical University, Kaohsiung,

3Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung MedicalUniversity, Kaohsiung, Taiwan

Purpose:

Congenital bilateral absence of the vas deferens (CBAVD) is a rare obstructive anomaly contributing to male factor infertility. Various congenital anomalies associated with CBAVD involve the seminal vesicles and epididymis. Physical examinations are often not reliable. However, transrectal ultrasonography (TRUS) can distinguish seminal vesicle and epididymal anomalies. In this clinical report, a rare case of CBAVD without seminal vesical anomalies is presented. PE and TRUS revealed no remarkable findings. The patient underwent vaso-epididymal anastomosis for the seminal tract obstruction and was accidentally diagnosed with CBAVD. Although ultrasonography is a reliable approach, surgical methods are critical for the diagnosis of CBAVD

Case report:

A 39-year old married male presented with a 12-month history of primary infertility to the outpatient urology clinic. He denied a history of smoking, drug abuse or other systemic diseases. A physical examination of the scrotum revealed a palpable bilaterally present vas deferens and minimal scrotal enlargement. A digital rectal examination was unremarkable. Semen analysis revealed normal volume fructose-positive azoospermia. A hormonal profile of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels was normal, except that

the serum testosterone level was slightly below the normal range (3.0 ng/ml). TRUS revealed bilaterally present seminal vesicles (Fig. 1). Under the impression of an obstruction in the seminal tract, scrotal exploration + vaso-epididymal anastomosis was performed. The winding testicular

artery was normal, but the vas deferens was aplasic with a blindly ending tail (Fig. 2). The caput epididymis on the left side, as well as the obstructed cauda epididymis, was revealed. The right vas deferens were absent after the right hemiscrotum was exposed, but the caput epididymis was identified without corpus and cauda didymides. The testis biopsy (3 × 3 mm) was obtained and histopathologically examined for the status of spermatogenesis, which revealed the presence of normally developed sperm. After the operation, the patient was sent for abdominal sonography because renal agenesis has been reported to closely associate with vasal agenesis due to the closeness of structures during embryogenesis.

Conclusion:

CBAVD patients with bilaterally present seminal vesicles are uncommon. Physical examinations involving palpations are often ineffective, and TRUS may lead to misdiagnosis. Herein, we presented a case with an obstruction in the seminal tract and bilaterally present seminal vesicles, and a diagnosis of CBAVD was accidental. Although ultrasonography is a reliable approach, surgical methods are critical for the diagnosis of these patients.