40 year old patient underwent 11/18/22 vasectomy followed by large left scrotal hematoma.
11/29/22 urologist determined that blood was congealed and not liquified enough for drainage. on 12/7/22, urologist determined that the blood wasn't liquid enough to make a difference if drained and decided to wait to surgically evacuate the next day.
Surgical drainage performed on 12/8/22. Noted concern about injuring blood supply to testes due to anatomy distortion, but felt that it appeared viable at end of case.
On 12/9, the patient returned to the office and the urologist noted that he was concerned that the procedure could have resulted in loss of flow to testicle. Urologist performed aa doppler that confirmed no blood flow to left testicle. An orchiotomy was performed later that day.
The scrotum subsequently became infected, which required antibiotic therapy for abscess, and further drainage.
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Do you believe there might have been medical error?
A vasectomy, performed properly should not result in loss of the testis. The testis has three arteries, the testicular artery, the artery to the vas, and the cremasteric branches. It is common to injure or divide the artery to the vas during vasectomy, but due to the presence of the other arterial supply, there should be no decompensation of the testis. Even the presence of the hematoma in itself should not significantly worsen blood flow to the testis. Therefore, at some point an additional insult to the blood supply happened.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The entire sequence began with an error in the initial procedure leading to the hematoma. This is a known and accepted complication. Once the hematoma led to both infections and loss of testis, the snowball rolled down the hill to a major complication, which had opportunities to be avoided.
What makes you a good expert for this case?
I am a practicing urologist and chief of the division for the past 13 years.
How often do you encounter cases similar to this one in your practice?
Rarely. This is a common procedure, and loss of testis is very rare. Hematoma is relatively rare, but happens at a reasonable rate.
Do you believe there might have been medical error?
Vasectomies are simple office space procedures. Loss of a testicle sonata car. The hematoma occurred, and subsequent to this patient underwent an additional exploration. After the expiration, there was a vascular injury which became apparent. In all likelihood, when the hematoma was evacuated the testicular artery was injured, and ithere was a loss of testicle. This is gross negligence.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
There is definite causality. It’s a security was injured at the time of the hematoma exploration.
What makes you a good expert for this case?
I’ve been in practice for over 20 years and I’ve done over 1000 vasectomies. I’ve never had loss of a testicle after a vasectomy. I’ve also never had to bring a patient back to the operating room to evacuate hematoma after the vasectomy meticulous hemostasis necessary as we are operating on enclosed space.
How often do you encounter cases similar to this one in your practice?
I’ve never had a testicular injury at the time of vasectomy. I have had to do several orchiectomy’s as a result of injuries at the time of vasectomy for patients, who are not, mine, were referred to me.
Do you believe there might have been medical error?
Regarding the case below - in not so many words, “res ipsa loquitor” Losing a testicle after a vasectomy is a terrible result that should never happen. Although post procedure bleeding/hematoma and infection are both acknowledged complications of this procedure that we specifically inform the patients of pre procedure, neither of those complications should lead to testicular loss.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Without knowing any other details I would suggest that the surgeon damaged the blood flow to the left testis, either during the original vasectomy procedure (which may explain the serious associated bleed) or, more likely, during the evacuation of hematoma on 12/8. I don’t think the timing of when he brought the patient back for drainage of the clot has any bearing on the complication…..it’s more likely what happened during that procedure (or during the vasectomy) where iatrogenic damage to the internal spermatic artery occurred.
What makes you a good expert for this case?
Thanks for giving me the opportunity to review this case…..as you know I have been practicing urology in NYC for 33 years (and have a NJ and FL medical license in addition to NY) and have done a couple of thousand vasectomies during that time. Happy to discuss this in more detail if you are interested in retaining me as an expert for this case.
How often do you encounter cases similar to this one in your practice?
Thankfully, a rare occurrence. .
Do you believe there might have been medical error?
Known complication of vasectomy (bleeding, infection). Patient went for evacuation of hematoma which the urologist did not believe would be drainable. Risks of that second operation were likely explained including loss of testicle. Anatomy distorted, resulting in loss of blood supply. Unintentional, unfortunate and unforeseen most likely.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Anatomy distorted, resulting in loss of blood supply. Unintentional, unfortunate and unforeseen most likely.
What makes you a good expert for this case?
Expertise in surgery and surgical complications, testicular anatomy, consequence of loss of testicle.
How often do you encounter cases similar to this one in your practice?
Rarely however I do deal with a lot of scrotal surgery for testicular cancers
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