Vasography
Vasography is an X-ray study of the vas deferens to see if there is blockage, oftentimes in the context of male infertility.[1] An incision is made in the scrotum, contrast is injected in the vas deferens, and X-rays are taken from different angles.[1] Thus, it is an invasive procedure and carries risk of iatrogenic scarring and obstruction of the vas.[2] Vasography has traditionally been considered the gold standard imaging modality for evaluating the seminal tract patency.[3]
To avoid performing an extra operation, vasography is encouraged to be done at the time of correction of the obstruction, and thus should not be done as an isolated outpatient procedure.[2]
History
[edit]Vasography was first described by Belfield in 1913, where a vasotomy was initially done and the vas deferens was subsequently intubated.[4][5] After almost 40 years of being overlooked, Boreau revived the procedure in the 1950s.[4] Then, vasography was somewhat overused for various fertility disorders and other diseases such as tuberculosis, prostate cancer, hemospermia, and compressive fibrolipomatosis, without considering the possible risks and complications from the procedure.[4] Today, vasography is used to determine the location of obstruction in azoospermic patients who have demonstrated spermatogenesis by testis biopsy.[6]
Indications
[edit]Vasography is absolutely indicated if 1) azoospermia (low sperm) is present, 2) testis biopsy shows complete spermatogenesis and many mature spermatids, and 3) there is at least one palpable vas.[7]
Vasography may be indicated if there is severe oligospermia (few sperm) with a normal testis biopsy, high levels of sperm-bound antibodies, or low semen volume and poor sperm motility.[7]
Complications
[edit]- Stricture – multiple attempts at vasography with sharp needles or imprecise closure of the vasography site may lead to stricture and obstruction.[7]
- Injury to the Vasal Blood Supply[7]
- Hematoma[7]
- Sperm granuloma – may be caused by leaky closure of the vasography site and can lead to stricture and obstruction.[7]
References
[edit]- ^ a b Diana Raab; Anita Levine-Goldberg (1 June 1999). Getting pregnant & staying pregnant: overcoming infertility and managing your high-risk pregnancy. Hunter House. p. 40. ISBN 978-0-89793-238-7. Retrieved 25 February 2012.
- ^ a b S. C. Basu (2011). Male Reproductive Dysfunction. JP Medical Ltd. p. 233. ISBN 978-93-5025-220-8.
- ^ Donkol, R. H. (2010). "Imaging in male-factor obstructive infertility". World Journal of Radiology. 2 (5): 172–179. doi:10.4329/wjr.v2.i5.172. PMC 2999021. PMID 21161032.
- ^ a b c Wagenknecht, L. V.; Becker, H.; Langendorff, H. M.; Schäfer, H. (2009). "Vasography-Clinical and Experimental Investigations". Andrologia. 14 (2): 182–189. doi:10.1111/j.1439-0272.1982.tb03122.x. PMID 7103137. S2CID 40695107.
- ^ Levi d'Ancona, C. A.; Netto, N. R.; Filho, A. C.; Stedile, J. A. G.; Billis, A. (1989). "Vasography: Experimental study". International Urology and Nephrology. 21 (1): 73–79. doi:10.1007/BF02549904. PMID 2714952. S2CID 1755690.
- ^ Bueschen, A. J.; Lockhart, M. E. (2011). "Evolution of urological imaging". International Journal of Urology. 18 (2): 102–112. doi:10.1111/j.1442-2042.2010.02677.x. PMID 21114686.
- ^ a b c d e f Campbell-Walsh urology / editor-in-chief, Alan J. Wein ; [editors, Louis R. Kavoussi ... et al. Philadelphia, PA: Elsevier Saunders. 2012. ISBN 978-1-4160-6911-9.