Vasography is an X-ray study of the vas deferens to see if there is blockage, oftentimes in the context of

male infertility Male infertility refers to a sexually mature male's inability to impregnate a fertile female. In humans it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is commonly due to deficiencies in the semen, ...

. An incision is made in the

scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum cont ...

, contrast is injected in the vas deferens, and X-rays are taken from different angles. Thus, it is an invasive procedure and carries risk of iatrogenic scarring and obstruction of the vas. Vasography has traditionally been considered the

gold standard A gold standard is a monetary system in which the standard economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the early 1920s, and from the la ...

imaging modality for evaluating the

seminal tract The seminal tract is a part of the male reproductive system and consists of Seminiferous tubules ( Tubuli seminiferi recti, Rete testis, Efferent ducts), Epididymis ( Appendix), Vas deferens (Ampulla An ampulla (; ) was, in Ancient ...

patency. 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.

History

Vasography was first described by Belfield in 1913, where a vasotomy was initially done and the vas deferens was subsequently intubated. After almost 40 years of being overlooked, Boreau revived the procedure in the 1950s. Then, vasography was somewhat overused for various fertility disorders and other diseases such as

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...

prostate cancer Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that sur ...

, hemospermia, and compressive fibrolipomatosis, without considering the possible risks and complications from the procedure. Today, vasography is used to determine the location of obstruction in azoospermic patients who have demonstrated spermatogenesis by testis biopsy.

Indications

Vasography is absolutely indicated if 1)

azoospermia Azoospermia is the medical condition of a man whose semen contains no sperm. It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen ...

(low sperm) is present, 2) testis

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

shows complete

spermatogenesis Spermatogenesis is the process by which haploid spermatozoa develop from germ cells in the seminiferous tubules of the testis. This process starts with the mitotic division of the stem cells located close to the basement membrane of the tubule ...

and many mature

spermatid The spermatid is the haploid male gametid that results from division of secondary spermatocytes. As a result of meiosis, each spermatid contains only half of the genetic material present in the original primary spermatocyte. Spermatids are co ...

s, and 3) there is at least one palpable vas. Vasography may be indicated if there is severe

oligospermia Terms oligospermia, oligozoospermia, and low sperm count refer to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm ...

(few sperm) with a normal testis biopsy, high levels of sperm-bound

antibodies An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...

, or low semen volume and poor sperm motility.

Complications

* Stricture - multiple attempts at vasography with sharp needles or imprecise closure of the vasography site may lead to stricture and obstruction. * Injury to the Vasal Blood Supply *

Hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...

* Sperm granuloma - may be caused by leaky closure of the vasography site and can lead to stricture and obstruction.

References

{{reflist Projectional radiography