Contribution of investigations to the diagnosis of bilateral vas aplasia.
BACKGROUND
Bilaterally absent vas deferens is a surgically uncorrectable cause of male infertility. It is usually diagnosed clinically. We evaluate the role of semen analysis and radiological imaging in providing objective evidence of vas aplasia.


METHODS
Twenty consecutive patients with clinically suspected bilateral vas aplasia were enrolled for this prospective study. They were investigated on the basis of an algorithm till corroborative evidence for vas aplasia was obtained. This successively included a semen analysis on at least two occasions, transrectal ultrasonogram (TRUS), pelvic magnetic resonance imaging (MRI) and scrotal exploration. The contribution of each investigation to confirming the diagnosis was evaluated.


RESULTS
Seventeen patients (85%) had a low volume ejaculate while all 20 had azoospermia and semen fructose levels below normal. Semen pH was non-acidic in 75% of cases and thus was not contributory to the diagnosis. TRUS and MRI were non-contributory in 30% and 50% of evaluations, respectively. The clinical diagnosis was found to be correct in all patients.


CONCLUSIONS
Vas aplasia is a clinical diagnosis. Low volume ejaculate with azoospermia and low or absent semen fructose is sufficient corroborative evidence and no further investigations are required for this diagnosis.
Kumar
Rajeev
R
Department of Urology, All India Institute of Medical Sciences, New Dehlhi, India. rajeev02@gmail.com
Thulkar
Sanjay
S
Kumar
Virender
V
Jagannathan
N R
NR
Gupta
Narmada P
NP
D000328:Adult; D000465:Algorithms; D000013:Congenital Abnormalities / Q000175:diagnosis; D005632:Fructose / Q000032:analysis; D006801:Humans; D008297:Male; D009845:Oligospermia / Q000175:diagnosis; D011446:Prospective Studies; D012661:Semen / Q000737:chemistry; D014649:Vas Deferens / Q000002:abnormalities*
D005632:Fructose