blocked vas deferens
Introduction
Introduction to vas deferens Sperm discharge must pass through the testicular output tube, epididymis tube, vas deferens, ejaculatory duct and part of the urethra. Blockage of any of the above can affect sperm discharge. The unilateral insemination pipeline is blocked, which has little effect on fertility; when the bilateral side is blocked, the sperm cannot be discharged normally, which will lead to infertility. Obstruction of the vas deferens can cause obstructive azoospermia, also known as pseudo-azoospermia. Its clinical manifestations are normal testicular size, no sperm, blood follicle stimulating hormone (FSH) and normal testosterone levels, testicular biopsy The result is normal. basic knowledge The proportion of illness: 0.001% Susceptible people: male Mode of infection: non-infectious Complications: oligozoospermia azoospermia
Cause
Cause of vas deferens clogging
Congenital anomalies (20%):
The vas deferens is congenitally undeveloped or stunted, and is not connected with the epididymis. It is often accompanied by a seminal vesicle that is not developed, resulting in less semen and no sperm. If the diagnosis is obstructive azoospermia, the cause and location of the obstruction should be preferred to restore the smoothness of the insemination pipeline. Consider ICSI for patients who are no longer able to pass.
Inflammatory stenosis (35%):
Various pathogenic bacteria cause inflammation of the vas deferens, forming scars, causing occlusion of the lumen, and severe cases of azoospermia. First, remove the primary cause, and firstly, anti-infective treatment for the infection factor, and then consider re-passing means.
Tumor (5%):
One of the causes of azoospermia is that the lumen of the vas deferens itself or adjacent organs is impaired. Spermatozoa, seminal vesicles, prostate tumors or cysts, or other organs around the body, cysts to produce oppression, feasible surgical resection.
Trauma or surgical injury (5%):
The patient has a history of surgery and injury. Such as hernia repair, spermatic hydrocele, high spermatic vein ligation, testicular and cryptorchidism, etc. caused by miscarriage or injury caused by vas deferens luminal obstruction. Vascular angiography can also induce or aggravate vas deferens obstruction.
Prevention
Vas deferens blockage prevention
Prevention of vas deferens clogging
1. Pay attention to the cleanliness of the reproductive system and prevent infection of various pathogens (especially sexually transmitted diseases).
2, most of the ectopic pregnancy is also caused by inflammation of the fallopian tube part of the blockage, after the occurrence of ectopic pregnancy, should avoid open fallopian tube resection, try to use laparoscopic fallopian tube fenestration, if circumstances permit, you can also use conservative therapy, so you can Keep the fallopian tubes.
3. The pipeline of the insemination is blocked. The method of checking the vas deferens can be determined according to the specific medical conditions. The easiest and most convenient method of testicular biopsy is to examine testicular biopsy.
4. If the levels of follicle stimulating hormone and testosterone in the blood are normal, the testicular biopsy is normal. It can be confirmed that the insemination pipeline is blocked, or the congenital vas deferens is insufficiency. Otherwise, it may be a problem with spermatogenesis. You can also do an X-ray photography, that is, a vas deferens serotoninography.
Complication
Vas deferens complication Complications oligozoospermia azoospermia
Blockage of the vas deferens leads to less sperm, no sperm, dead sperm, weak sperm and so on.
Symptom
Symptoms of vas deferens clogging common symptoms vas deferens pain vas deferens occlusion ejaculation pain weakness nodules
1, the patient has a history of infertility may have a weak or incomplete orgasm, ejaculation pain or weakness.
2, may have a history of reproductive system infection, surgery, injury.
3, physical examination touches the vas deferens or epididymis nodules, thickening, beaded changes or lack of.
Examine
Examination of vas deferens
1, semen routine examination of semen without sperm or sperm count.
(1) For the obstruction above the bilateral ejaculation tube (excluding the prostate), the semen is characterized by low fluid volume, no sperm, low fructose content, acidity, and high citric acid content.
(2) Obstruction of the vas deferens above the prostate (including the prostate), showing semen reduction, no sperm, PH value is neutral or alkaline, fructose and citric acid content are low.
(3) If there is a small amount of sperm in the semen, it suggests that the insemination may have partial or partial obstruction.
2, inferior tract scrotum invasive scrotum small incision, fixed and display vas deferens, with a 2l needle, first in the direction of the epididymis puncture 0.5ml about 60% compound diatrizoate, can show the distal vas deferens and epididymis, then can Puncture in the direction of the seminal vesicle, inject 2-3ml compound diatrizoate, which can show the proximal vas deferens, seminal vesicle and ejaculatory tube. Recently, many scholars have reported direct percutaneous vas deferens angiography, no need for scrotal incision, normal vas deferens Should be shown as vas deferens, seminal vesicles, ejaculatory ducts, normal position, are filled with contrast agent.
3, surgical exploration of the scrotum intraoperative exploration, is another important means of diagnosis of obstruction of the vas deferens, because some lesions can not be found by physical examination or vas deferens angiography, the order of exploration is testicular, epididymis, vas deferens, while exploring Feasible testicular biopsy, exploration and surgical treatment should be carried out at the same time to avoid secondary surgery.
Diagnosis
Diagnostic identification of vas deferens
If the main symptoms are azoospermia, it is necessary to identify the testicular azoospermia and the azoospermia caused by blockage of the insemination pipeline. The testicular biopsy can be used for identification. If the testicular biopsy is normal, the vas deferens should be performed to understand the patency of the vas deferens. If there is a small amount of sperm in the semen, it suggests that the insemination may have partial or partial obstruction.
