MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Azoospermia.
POSTOPERATIVE DIAGNOSIS:
Azoospermia with obstruction of ejaculatory ducts.
OPERATION PERFORMED:
Right vasogram and testicular biopsy with transurethral resection of ejaculatory ducts.
SURGEON:
John Doe, MD
ASSISTANT:
None.
ANESTHESIA:
General LMA.
OPERATION IN DETAIL: After the patient was brought to the surgical suite, the patient was placed on the surgical table in the supine position. He was given general LMA anesthesia and then placed on the stirrups in the dorsal lithotomy position. He was shaved and prepped appropriately with Betadine and draped in aseptic fashion. Testicles were injected with 0.5% Marcaine, as well as median raphe.
After this was done, the testicles were dissected out on the right side. Testicles showed a normal consistency with a normal epididymis. The vas was palpable. There was no significant dilatation of the veins around the epididymis. However, the color, size, and consistency of the epididymis and testicle were consistent with that of a normal-appearing testicle.
Then, an incision was made in the tunica albuginea and the testicular contents were removed and sent in Bouin solution for permanent evaluation. After this was completed, the testicle was repaired and the vas was dissected out using the ring retractor. Once dissected out, we transected the anterior wall of the vas and then dilated it with dilators. We were able to pass a #2 Prolene stitch, greater than 12 cm, into the ejaculatory ducts indicating that this site was patent. We placed the scope in the bladder but could not see the tip of the Prolene.
We then injected methylene blue. There was a very narrow stream of dye coming from the very cystic verumontanum. This was very unusual, did not show clearly defined ejaculatory ducts that were open with good output. At this juncture, we then cannulated and placed contrast to show an outline of the convoluted vas as well as the ampulla of the vas and ejaculatory ducts. There was the dye that did enter the bladder, but this was done under tremendous pressure and we did document that the opening from the vas to the verumontanum was inadequate.
Because of these findings, we felt that it would be best to resect the verumontanum. The verumontanum was resected without incident. Hemostasis was achieved. This was done with a resectoscope. At the end of that procedure, the area was fulgurated and a #24 French catheter was placed in the bladder and the bladder was irrigated to clear.
The scrotal area was then closed with a running #2-0 chromic stitch and the vas was repaired using a #8-0 Vicryl in an interrupted fashion and it was reinforced with a #2-0 chromic. After the vas and the testicle contents had been placed, then the #2-0 chromic was used in order to close the skin and close the sac of the scrotum. The patient tolerated the procedure well. There were no surgical anesthesia complications.
