Ultrastructural features of the vas deferens from patients undergoing vasectomy and vasectomy reversal.

Despite more than 30 million vasectomies, the ultrastructural features of the epithelium of the vas deferens (VD) of healthy fertile men, as well as the effects of vasectomy at both proximal (testicular) and distal (abdominal) regions of the VD relative to the initial site of incision, have yet to be fully elucidated. In the present study, the VD from 22 fertile men undergoing vasectomy and 7 vasectomized men undergoing vasectomy reversal were examined by light and transmission electron microscopy. In fertile men, aside from cellular organelles involved in endocytosis and merocrine secretion, the epithelial principal cells showed protrusions of their apical cytoplasm between adjacent microvilli, referred to as "apical blebs." The latter contained solely numerous ribosomes/polysomes and few endoplasmic reticulum (ER) cisternae, unlike the presence of lysosomes, lipofuscin granules, mitochondria, and the Golgi apparatus in the apical principal cell cytoplasm, suggesting the segregation of organelles within blebs. Many apical blebs presented a bulbous extremity with a thin stalklike attachment connecting them to the apical principal cell surface, while others appeared to be isolated and well removed from it, suggesting that blebs are capable of detaching and being liberated into the lumen. We hypothesize that apical blebs represent a type of secretion, referred to as "apocrine secretion." In men undergoing vasectomy reversal, the VD proximal (testicular) to the vasectomy site showed a reduction in the size of principal cells and their microvilli and in the number of apical blebs. In contrast, the lumen of the VD distal (abdominal) to the vasectomy site was virtually abolished, with the epithelium reduced to a flattened layer of cells showing a paucity of organelles and no apical blebs, suggesting that these cells become undifferentiated in the absence of seminal fluids. Taken together, these data may explain, in part, the decreased pregnancy rate noted after vasectomy reversal despite a patent anastomosis.