Vasectomy Reversal Impedes Blood Flow to Patient’s Testicle

This case involves a male patient who underwent a reverse vasectomy. For 2 days after the procedure, the patient experienced continuous pain and incontinence. He called the hospital multiple times but was only told to take pain medication. On the second day after his operation, the patient could not withstand the pain and incontinence anymore and presented to the emergency department. Further workup identified a hematoma in the patient’s scrotum, which was blocking blood flow to the testicle. The patient’s urologist was contacted, who said he had some difficulties during the procedure because the prior vasectomy incision was unusually placed. He stated that there was some concern for the vascular inflow of the testicle, although at the end of the procedure, blood flow seemed normal. The patient was not informed of the complication at any point after the surgery. The patient has since undergone multiple surgeries, but has since lost fertility.

Question(s) For Expert Witness

1. Do you have experience performing vasectomies?

2. Are you familiar with the complication 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, and sexual health. I perform 2-3 vasectomy reversals per week and 5 vasectomies. 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, but a hematoma itself should not occlude blood flow to the testicle. It sounds concerning that an arterial injury occurred at the time of reconstruction. 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. However, if an arterial injury did occur, and it was repaired or intervention taken to address this possible injury, then yes this should have been discussed with the patient. Full disclosure is generally the best practice.