After 18 months and 3 samples, I was still showing a positive sample. Not much, but enough to not be cleared. I read your response to Dave about the low counts and reasons for them but this is what I was told. I could have a possible minute vas that was not seen when done in the office with a small center incision in the scrotum. So I had a second procedure done in the hospital. Two side incisions this time. When I questioned the physician, no extra vas was found. I asked what caused the positive results then, his response was a possible spontaneous reconnection of the vas. Now how is that possible if they were cut , burned, etc. and is that even such a term?Dr. Edward Karpman
A duplicate vas deferens on one or both sides can be a confounding cause of persistent sperm in the ejaculate after a vasectomy. However, these cases are rare and there are only a handful of such reported cases in the medical literature. Usually, the vas deferens is not completely duplicated but in a “Y” shape. A duplicate vas deferens is also usually apparent on physical examination prior to the vasectomy, alerting the physician to take extra care when performing the vasectomy. It seems unlikely that the small atretic vas deferens would be confused for the normal-sized vas deferens, even if duplication was the case. The findings at the time of the second vasectomy excludes this possibility.
The more likely explanation in this case is that the vas deferens was not ligated on one side or the ends have grown back together. One of the drawbacks of using a single incision is that the vas deferens can be ligated twice on the same side. This happens when the vas is pulled towards the single incision and the physician inadvertently pulls the same vas deferens towards the midline incision twice. Anecdotally, I have heard of several such instances. The exact incidence of this is unknown.
A vasectomy can also fail if the ends grow back together (re-canalize or re-connect). This is less likely when the physician removes a segment of the vas deferens, cauterizes the ends and places a ligature or clips on both ends. The overall success of vasectomy is 99.7%.
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