Patient Loses Testicle Following Reverse Vasectomy

This case involves a male patient who underwent a reverse vasectomy with the defendant urologist. During the several days following the procedure, the patient kept experiencing increasing pain, discomfort, and incontinence. Each time he called the urologist, the patient was told to take pain medication. A week after the operation, the patient could not withstand the discomfort and incontinence anymore and presented to the emergency room. Further workup identified a hematoma in the patient’s scrotum blocking blood flow to the testicle. The patient’s new urologist contacted the defendant urologist and was informed that the vasectomy reversal had been difficult. In particular, the site of the prior vasectomy was extremely low with the testicle. The defendant urologist stated that there was some concern for the vascular inflow of the testicle. Although at the end of the procedure, the testicle did appear viable and pink. Neither the patient nor his wife were informed of this at any point after the surgery. The patient has since undergone multiple surgeries including having one of his testicles removed and has lost fertility.

Question(s) For Expert Witness

1. Please describe your experience performing vasectomy reversals.

2. How often do vasectomy reversals lead to the complications that occurred in this case?

3. Should the patient have been informed of the difficulties/complications encountered during the surgery?

Expert Witness Response E-057569

I am a specialist in vasectomies, vasectomy reversals, genital reconstruction, male fertility and microsurgery, sexual health and erectile dysfunction. I perform 2-3 vasectomy reversals and 5 vasectomies per week. Loss of a testicle following vasectomy reversal is not a common complication. I am not sure if the reversal was performed microsurgically or not, which is the standard of care. Certainly, a hematoma can occur postoperatively following scrotal surgery. However, a hematoma itself should not occlude blood flow to the testicle. It sounds concerning that an arterial injury occurred at the time of reconstruction. I would need to review the records of course in detail, but I am very familiar with all of these complications of genital surgery. If the surgeon had thought that an artery was damaged at the time of surgery, but upon further inspection, it appeared fine, then that is not necessarily something that needs to be discussed with the patient. If however, an arterial injury did occur, and it was repaired, or intervention was taken to address this possible injury, then yes, this should have been discussed with the patient. Full disclosure is generally the best practice. I would need to look at the records to know what happened intraoperatively and if that should have been discussed postop.