Vasectomy

Intravenous angiography is mainly used for infertility caused by obstruction of the vas deferens in male infertility. For example, spermatozoa have no sperm, but testicular biopsy testicular spermatogenesis is normal. It can be confirmed through incision angiography to confirm whether the insemination pipeline is blocked or blocked. Specific parts in order to take the corresponding treatment measures. After the angiography, the bath and sexual life are for two weeks, and antibiotics can be given as appropriate to prevent infection. Basic Information Specialist Category: Male Examination Check Category: CT Applicable gender: whether the male is fasting: not fasting Reminder: At least three days before the inspection, you cannot be in the same room. Normal value Vas deferens The normal length is about 40-50cm, and the inner diameter of the lumen is about 1mm. Before the vas deferens move to the ampulla, a small section of the tube becomes thinner, forming an isthmus. The vas deferens on both sides are more symmetrical into the basin. The ampulla is located above the capsule. Irregularly twisted strips. The main pipe diameter is about 2-3mm and the length is about 3-7mm. First, a 1.5mm section is traversed inward, then slanted downward, and the end is combined with the seminal vesicle drainage tube to form an ejaculatory duct. Most of the ampulla's edges are irregular, and may have diverticulum-like changes, forming feathers, and a few edges are smooth. The ampullas on both sides are mostly symmetrical. Seminal pouch Normally, the seminal vesicle has a smooth and irregular leaf shape, in which a tortuous strip shadow formed by the seminal vesicle tube is visible, which is located below the ampulla, and most of the gap exists between the two, a few The images partially overlap. The shape of the seminal vesicle can be roughly divided into three kinds of grape shapes with a plurality of circular shadows; 2 curved and monotonous curved tubes; 3 curved and overlapping coils. The seminal vesicle diameter is basically the same except that the drainage tube is thin. The maximum width is about 4-5mm. The seminal vesicle image has a side length of 5.0 ± 0.6cm along its longitudinal axis and a length of 4.6 ± 0.8cm on the left side. Both sides are basically symmetrical in size and position. Ejaculatory duct On the X-ray film, the normal ejaculatory tube has a long cone shape with a narrow width and a narrow width, and has a length of about 1.6 ± 0.6 cm, a tube diameter of 1.5 ± 0.6 mm, a smooth outer edge, and a large number of inner edges. Unequal wrinkles or jagged images, the sides are basically symmetrical. Its shape can be roughly divided into four types of 1 "V" type ejaculatory tubes as straight tubes, the width of the two is narrow and narrow (22.1%); 2"11" type of two tubes are basically equal (47.1%); 3 The "X" type of two tubes were slightly outwardly bent (25.5%); the 4" ()" tubes were significantly inwardly curved (5.3%). Vas defere ampulla The X-ray film has an irregular twisted strip shadow on the ampulla, firstly traversing inward and downward, then slanting downward, and the end merges with the seminal vesicle drainage tube into an ejaculatory duct. The edges of the ampulla are irregularly dilated or villi-like, with a few edges being smooth. Before connecting the ejaculatory duct, the ampullary supervisor has more expansion and widening, and the end is finer and then connected to the ejaculatory duct. The angle between the ampulla and the seminal vesicle is clear. Epididymis The vas deferens angiography technique is an art of operation with very high technical requirements. A good epididymal vas deferens angiography needs to show the scrotum end of the vas deferens. The lumen is the same as the seminal vesicle, which begins to show obvious in the epididymis. Thinning and bending, as the contrast agent is further pushed in, the closer the testicular end epididymis tube is, the finer and more curved, until the developing film is unclear. Clinical significance Abnormal result Vas deferens obstruction Common causes include bilateral inguinal hernia injury, scrotal surgery, gonorrhea, vas deferens tuberculosis, scar formation after inflammation, invasive vas deferens of prostate cancer, and partial defects of congenital vas deferens. Sperm angiography can determine the location and extent of vas deferens obstruction, especially the bilateral vas deferens caused by bilateral inguinal hernia injury can clearly locate the vas deferens and provide a valuable diagnostic basis for future vas deferens anastomosis. If the ejaculatory duct is not smooth or completely blocked, the ejaculatory duct is often not developed, and the ampulla is obviously expanded. Seminal vesicle disease 1) Before the seminal vesicle, vas deferens or calcification, the bladder area is taken flat to exclude stones or calcification other than the spermatic tract and compared with the X-ray film after contrast. The seminal vesicle is blocked by stones and the contrast agent passes through the obstacle. At the end of the vas deferens, the contrast agent is difficult to inject, the resistance is large, and the subject has no feeling of urinary sensation. The calcification of the vas deferens also affects angiography. 2) Clinical diagnosis of seminal vesicle tuberculosis If epididymal tuberculosis is diagnosed, it should be contraindicated for seminal vesicle angiography to prevent the spread of the lesion. The seminal vesicle tuberculosis showed that the seminal vesicle was distorted, dilated, and the shape was atrophied, and the image was destroyed, and the ejaculation tube was reversed. The lumen of the ejaculatory duct became smaller. If a cavity is formed, the edge of the worm is visible because the contrast agent is mixed with the cheese-like substance. When the seminal vesicle is severely damaged, the lumen can be completely occluded, and the affected side of the seminal vesicle cannot be developed. 3) If there is inflammatory secretion or bleeding in the cyst of non-specific seminal vesiculitis, the development is unclear, and the viscosity of the inflammatory secretion is directly related to the contrast agent. In addition, the edge of the seminal vesicle is irregular, and some show that some or all of the seminal vesicles are dilated, and there is a phenomenon of contrast agent spillover. This is a characteristic of non-specific seminal vesiculitis, which is not the case in diseases such as seminal vesicle tuberculosis or prostate cancer. 4) seminal vesicle cyst, seminal vesicle diverticulum is rare, angiography shows that the seminal vesicle is dilated, and the normal structure of the seminal vesicle and the end branch of the vas deferens disappears, showing a single cystic enlargement, and part or all of the seminal vesicle is dilated. Epididymal disease Due to epididymal tuberculosis and gonorrhea, epididymal ducts are often not developed, and even a considerable number of patients will fail due to occlusion of the vas deferens in the epididymis and scrotum. However, most of the epididymal tube obstruction is that the epididymis end of the vas deferens is well developed, but is blocked at the junction of the epididymis tube and the seminiferous tubule. If the problem is not clear, it will often lead to a very understanding of the doctor and the patient. That is, the testicular biopsy test testicular spermatogenic function is normal, showing obstructive azoospermia, and the vas deferens angiography and the epididymal end are well developed, why What is the result? It is actually the reason why the pathology and angiography are not well understood. Adjacent organ disease 1) Prostatitis can expand or contract the seminal vesicle, which is spherical and poorly filled. There was a diverticulum-like change in the distal ampulla, and there was no change in the ejaculatory duct. 2) When the prostate is proliferated, the seminal vesicle and the ampulla are enlarged, the sides are symmetrical and raised upwards, and the edges are smooth. The ejaculatory duct can be expanded several times more normally, and the lumen is extended and moved closer to the midline. The concave side in the normal direction becomes concave toward the outside. 3) When the prostate tube is irregular in the edge of the ejaculatory duct, changes such as defects, deformation, stenosis or sudden cutoff can be seen. In severe cases, the seminal vesicles and the ampulla were deformed, the image was incomplete or not developed, and the stump of the vas deferens was a stiff rat tail. (5) Endocrine disorders Endocrine disorders have a great influence on the development of vas deferens, which can cause changes in morphology and weight. Morphological changes can be shown by sperm angiography, and weight changes can be determined by biological quantitative methods. In addition to the obstruction of the insemination pipeline and congenital malformation, the vas deferens angiography has a certain significance for the diagnosis of various anatomical structures caused by inflammation, tumors and trauma. It also helps to understand the pathology of adjacent tissues. People who need to be checked 1. Sperm discharge disorder Male infertility semen examination without sperm, but testicular biopsy has spermatogenic ability (there are sperm in the seminiferous tubule), can be used for vas deferens seminal vesicle angiography, observation of the vas deferens and its ampulla and ejaculatory lumen, seminal vesicle There are no obstacles to discharge. By angiography, attention should be paid to the location of the obstruction, the degree of stenosis and the extent of the stenosis. 2. Seminal vesicle itself Aspermatism and retrogradeejaculation often need to be diagnosed by seminal vesicle angiography, and differentiated from infertility caused by seminal vesicle tuberculosis, seminal vesicle stones, seminal vesicle cyst, non-specific chronic seminal vesiculitis. 3. Endocrine dynamic observation The seminal vesicle is a male sexual system parasitic organ, which is closely related to sexual function. Changes in the individual's endocrine function can impede the development of the seminal vesicle or cause congenital malformations, leading to infertility. Changes in the morphology of the seminal vesicle can be inferred by seminal vesicle angiography. Precautions Taboo before inspection: 1. You must not be in the same room for at least three days before the inspection. 2. Empty the bladder before doing vas deferens. Requirements for inspection: 1. If you have iodine allergies, you should not conceal the history of iodine allergy from your doctor. You must do an iodine allergy test before each angiography. 2, after angiography, bathing and sexual life for two weeks, antibiotics can be given as appropriate to prevent infection. Inspection process Venous angiography method: 1. After local anesthesia, use an external fixation forceps to clamp the vas deferens together with the tight scrotum skin into the fixation ring. The fixed glycoside is oriented toward the lower extremity end of the subject. 2. The assistant will fix the clamp head to the top of the fetal head. The surgeon uses the left thumb and index finger to pinch the two sides of the vas deferens in front of the wrong head, and the right hand holding the vas deferens needle (8th sharp needle), in the middle of the most prominent part of the vas deferens Puncture the anterior wall of the vas deferens in an approximately vertical direction, about 2 mm deep. When puncturing a vas deferens tissue, there is often a kind of "sex sexy". The slope of the needle must be consistent with the longitudinal axis of the vas deferens during puncture, otherwise there may be a possibility of piercing or cutting the vas deferens. 3. Unplug the No. 8 needle and fix the finger of the vas deferens. Immediately insert the No. 6 blunt needle into the distal end of the vas deferens along the punctured hole. When the needle enters the hole in the anterior wall of the vas deferens, there is often a feeling of tightening, and with a little force, there is a feeling of puncturing, indicating that it has entered the lumen. 4. To determine whether the puncture is successful, in addition to the subjective feeling of the surgeon, the following methods can be used to identify: (1) seminal vesicle perfusion test: the operator uses the left thumb and index finger to gently pinch the vas deferens near the subcutaneous ring, which will contain 1% procaine. The 5ml syringe is attached to the inserted 6th blunt needle seat, and suddenly injects 2~3ml. If the needle is in the lumen, pinching the finger of the vas deferens, the impact of the sudden expansion, hardening and pressure increase of the vas deferens continues. Injected a few milliliters, the subject often has a sense of urinary sensation, local edema. (2) telangiectal blind end pressure injection test: the assistant uses the thumb and forefinger to pinch the vas deferens near the subcutaneous ring. The surgeon uses the same method to pinch the vas deferens in front of the pinhole, and after pumping back no blood, inject 2ml of air, after a few seconds. Relax the finger of the bolus. If the puncture is successful, the syringe needle automatically returns to the original scale due to the pressure relationship; if the seminal vesicle is not pinched, the air is injected into the spermatic tract, and the surgeon produces a strong sense of urinary sensation, indicating successful puncture. On the other hand, if the puncture fails, there is a significant sign of subcutaneous accumulation around the needle, and there is no sense of urine. Not suitable for the crowd Inappropriate population: Patients who are allergic to contrast agents.

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