Androlog Mail
To Androlog colleagues:
In response to Dr. David Almond's query re testicular infarction following
simultaneous varicocelectomy and ipsilateral epididymectomy:
It is most important to remember that the deferential artery and vein
supplying the vas, epididymis and testicle may be the sole remaining source
of blood supply to the testis following a varicocelectomy if the internal
spermatic artery has been inadvertently ligated. Thus, with the
epididymectomy, you have, in effect, severed the testicle's remaining blood
supply.
At the annual meeting of the American Society for Reproductive Medicine in
Orlando Florida in October 2001, Dr. Marc Goldstein, who uses an operating
microscope, and his fellows reported that he had certain knowledge that he
himself had inadvertently ligated the internal spermatic artery during
varicocelectomy on 18 different occasions, and that in none of these
patients was there a drop in sperm count, or any pain, or any atrophy of the
involved testicle (because he had preserved the deferential artery and
vein). {Abstract # O-128, 10/23/2001}
Urologists should be wary of a patient's request for a sterilizing
vasectomy after the couple have had all the desired children following a
successful bilateral varicocelectomy... Remember that the deferential
artery and vein may be the sole remaining source of blood supply to the
testis if the internal spermatic artery has been inadvertently ligated.
You will then sever the testicles' remaining blood supply, and you will
have performed a castration instead of a sterilization. A bilateral
vasectomy performed following a unilateral varicocelectomy may only result
in a hemi-castration. In either case, you will have an unhappy patient!
By the same token, be very cautious in performing a bilateral vasectomy-
reversal procedure or an epididymo-vasostomy combined with a varicocelectomy
at the same time.
Richard D. Amelar, M.D.
Professor of Clinical Urology
N.Y.U. School of Medicine
ramelar@frontiernet.net
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