Congenital bilateral absence of the vas deferens (CBAVD) wit
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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.

Here presents a case of a 39-year old 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 . Under the impression of an obstruction in the seminal tract, scrotal exploration + vaso-epididymal anastomosis was performed.

The patient received general anesthesia and was placed in the supine position. A 1-cm longitudinal scrotal incision was made, and the vas deferens was exposed in the left hemiscrotum. The winding testicular artery was normal, but the vas deferens was aplastic with a blindly ending tail . 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 epididymides. 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 be closely associated with vasal agenesis due to the closeness of structures during embryogenesis. However, the findings were unremarkable. The patient recovered after the procedure, and intracytoplasmic sperm insemination was recommended.

Conclusively, CBAVD patients with bilaterally present seminal vesicles are uncommon. Physical examinations involving palpitations are often ineffective, and TRUS may lead to misdiagnosis.