[Reprinted from the Journal of Cutaneous and Genito-Urinary Diseases 
for January, 1896.] 
CASE OF DOUBLE LIGATION 01’ THE VASA DEFERENTIA FOR 
HYPERTROPHY OF THE PROSTATE. 
By F. TILDEN BROWN, M. D., 
New York. 
TMcB., aged seventy, male. Ireland. Married. Cabdriver. 
Admitted to Presbyterian Hospital, June 22, 1895 ; discharged 
• August 27, 1895. Cured. 
Previous History.—Had never bad rheumatism, syphilis, or mala- 
ria. Had, when young, a short attack of gonorrhoea. For the past 
nine or ten years he was troubled with frequent urination. Five years 
ago he had a sudden attack of retention, with constant dribbling, which 
yielded to Sitz baths, rest, and catheterization. Afterward involuntary 
dribbling from overdistention troubled him at times, and frequency 
was greater than it had been before. 
Present Illness.—Two weeks ago on getting up he was unable to 
pass any urine. He was treated for live days, as on the previous occa- 
sion of retention, without improvement of his symptoms, and then sent 
into the hospital. 
On admission, complains of inability to pass a drop of urine. 
Temperature, 98'2° ; pulse, 96; respiration, 18. Urine acid ; shows a 
moderate trace of albumin, some pus, and muco-purulent shreds; no 
casts. Lungs emphysematous. Rectal examination shows a rather sym- 
metrical enlargement of the prostate, suggesting the size of a billiard 
ball. Bladder examined negatively for stone. Meatus urinarius ad- 
mits only 17 F. instruments. No difficulty in passing such sized in- 
struments through the prostatic urethra. 
Treatment.—Regular catheterization, rest in bed, light diet. 
Copyright, 1896, by D. Appleton and Company, 2 
Original Communications. 
July 2d.—Meatus and fossa navicularis incised so as to admit in- 
struments of 32 F. caliber to the bladder, thinking it possible that this 
might react favorably upon the condition of complete retention if the 
cause resided in the posterior urethra. During the next ten days the 
patient was kept in bed and regularly catheterized with a gun silk in- 
Patient during the third week after double ligation parsing urine voluntarily. 
Btrument of 30 F. There was not the slightest improvement, and all 
the most careful observation pointed to the hypertrophied prostate as 
the reason for his retention. 
On July lltli ten minims of a four-per-cent solution of cocaine was 
injected into the tissues overlying the spermatic cords close to the ex- 
ternal abdominal ring. 
The vasa deferentia was separated to the extent of an inch from the 
cord, and double ligatures of tine silk a quarter of an inch apart placed 
on each vas. The vas was not severed. Wounds were closed with con- 
tinuous fine black silk suture, and covered with the usual iodoform 
gauze dressing. The patient was returned to bed and kept under the 
same conditions as those pertaining before the operation. Until July 
18th, seven days after the operation, all urine was passed through a 3 
Double Ligation of the Vasa Deferentia 
catheter. On this day a few drops, estimated as two drachms, were 
passed voluntarily. From this date until he was discharged as accu- 
rate measurements as was possible were kept of the quantities of urine 
passed through the catheter and the urethra respectively. 
By catheter. 
By urethra. 
Greatest amount of 
residual urine found at 
anytime each day after 
voluntary micturation. 
July 19 
All. 
0 ounces. 
“ 20 
U 
0 
a 
“ 21 
32 ounces. 
2 
a 
“ 22 
24 
U 
11 
u 
“ 23 
49 
(4 
H 
“ 
“ 24 
28 
44 
5 
a 
“ 25 
31 
a 
10 
a 
“ 26 
28 
u 
12 
“ 
“ 27 
41 
a 
20 
“ 
“ 28 
23 
a 
15 
“ 
“ 29 
29 
a 
25 
a 
12 ounces. 
“ 30 
13 
a 
29 
a 
6 
a 
“ 31 
13 
a 
27 
a 
5 
a 
Aug. 1 
5 
a 
28 
“ 
5 
a 
“ 2 
9 
“ 
39 
“ 
9 
a 
“ 3 
5 
“ 
42 
a 
5 
“ 
“ 4 
7 
a 
31 
a 
7 
u 
44 5 
Catheter not used. 
43 
“ 
“ 6 
“ 
a 
44 
“ 
“ 7 
5 ounces. 
47 
a 
5 
“ 
“ 8 
5 
“ 
39 
“ 
5 
a 
“ 9 
H 
“ 
32 
a 
H 
“ 
“ 10 
H 
u 
38 
a 
H 
“ 
“ 11 
3 
a 
37 
44 
3 
44 
“ 12 
3 
a 
27 + 
44 
3 
u 
Measurements of urine here discontinued. 
After August 1st the patient was catheterized once a day imme- 
diately after some one morning urination ; during this time the great- 
est quantity of residual urine found was nine ounces, and the smallest 
quantity two ounces and a half. 
Since being discharged from the hospital this patient has been under 
my observation. lie has returned to his old occupation, and reports 
himself better than at any time during the past ten years, in that his 
urinary intervals are longer, and he has no vesical discomfort. I have 
always tested the amount of residual urine, and never found more than 
three ounces and a half, and generally two or two and a half. He uses 
a catheter once daily. There is no evidence of testicular atrophy or of 
any change in the epididymes, as remarked by physicians who have 
examined him at society meetings where he has been shown. The 
only disturbance which may have been attributable to the operation 
was a sense of heat and itching in the feet and legs, especially at night. 
This possible reflex symptom is not so much complained of at present. 4 
Original Communications. 
The urethral distance is now eight inches and three quarters. The 
prostate is about the size of a duck’s egg. 
When this patient gave me the privilege to attempt anything for the 
relief of his retention I decided to test the efficacy of the trifling opera- 
tion already described. If it failed, I had a chance of trying castra- 
tion. When Dr. Mears suggested double ligation of the vasa deferentia 
as a substitute for Dr. White’s operation, the latter promptly tested it 
on dogs, and was surprised to find that little if any difference in the 
marked loss of weight of the prostate was shown bv the two proce- 
dures. 
I have not seen recorded in this country any operation of this kind 
on man for the specific purpose indicated prior to my own ; but I 
presume it has been done, and that this statement will be sufficient to 
elicit responses which will correct my oversight. 
The functional result following (and presumably due to) the opera- 
tion of double ligation has been so satisfactory in my single case that 1 
feel I could not have asked tor more had it followed castration. And 
when the relative risks of double ligation and prostatectomy, whether 
intra- or extra-vesical, are considered, I would not for a moment hesi- 
tate, in a similar case, to first give the patient the benefit of a chance 
of functional restoration by double ligation. 
Having observed one fatal issue after castration where vigor and 
general health were apparently as good as in my subject, I came to 
view the procedure, in elderly people, as attended with a risk not easy 
to explain. Consequently a procedure which could omit systemic 
anesthetization and the removal of any organs, even if they were but 
sentimental attachments, appealed to me. In fu ure cases of prostatic 
hypertrophy causing retention I will continue to test the efficacy of 
double ligation ; and if its results shall be found to compare favorably 
with those attributed to castration, the most striking advantage, apart 
from the increased safety, will be manifest in the patient retaining not 
only his anatomy but whatever virility these organs may be possessed 
of; for the artificial occlusion of the vas ought not to affect virility 
more than does an occluding funieulitis or epididymitis in connection 
with gonorrhoea.