Patient Loses Testicle Following Reverse Vasectomy

Case Overview

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.

Questions to the Urology expert and their responses

Please describe your experience performing vasectomy reversals.

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.

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

Loss of a testicle following vasectomy reversal is not a common complication. 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.

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

About the expert

This highly qualified, board-certified expert earned her bachelor's degree from Harvard University and her medical degree from Albany Medical College. This was followed by an internship in general surgery at the Johns Hopkins Hospital and a residency in urology at the Johns Hopkins Hospital. She then pursued her fellowship training in reproductive medicine and surgery at Baylor College of Medicine. This expert is a member of numerous prestigious medical societies including the International Society of Cosmetogynecology and the International Society for the Study of Women?s Sexual Health. She is also a reviewer of 2 prestigious medical journals and has authored 17 peer-reviewed journal articles, 3 book chapters and 10 abstracts in her field. She has previously served as an assistant professor of urology, obstetrics and gynecology at The Johns Hopkins Hospital. She currently serves as the director of fertility, microsurgery and sexual health at a private group practice, as a clinical Instructor of urology at a major university hospital center, as the founder and director of an aesthetic surgery center, and as regional director of fertility at a reproductive science center.

E-057569

Specialties:

Urology