Post-Vasectomy Complications: Pain and Recovery Issues

After sterilization..?

Hello, doctor.
I would like to ask for your professional opinion as my husband recently underwent a vasectomy, but there have been significant complications.
I need to understand the causes and factors involved better.
If possible, could you please provide some answers? Thank you!
My husband had the surgery on April 5th at 1:30 PM.
After the procedure, he did not engage in any activities that were prohibited post-surgery; he only walked for about three minutes (along the roadside) and then returned home after eating.
However, by 3:00 PM that same day, he began to experience pain in his scrotum, which was accompanied by bladder pain.
By 9:00 PM, his scrotum had become extremely swollen, prompting us to return to the hospital.
The doctor indicated that this was due to a rupture of internal blood vessels and he underwent a second surgery to clear most of the internal congestion.
After the surgery, we were not admitted for observation and were sent home without any pain medication or instructions for follow-up.
That night, my husband was in so much pain that he was crying.
On the morning of April 6th, I took him back to see the doctor, who admitted to forgetting to prescribe pain medication and then provided us with some.
My husband is currently unable to stand or walk for long periods due to the pain.
1.
Is it possible that the doctor did not perform the surgery correctly?
2.
My husband’s scrotum has swollen to a black area approximately twenty centimeters in diameter.
Will it return to its original appearance?
3.
Was there any negligence on the part of the doctor in caring for the patient?

Pei, 30~39 year old female. Ask Date: 2010/04/11

Dr. Xu Weikai reply Urology

Hello, I am glad to assist you, and I am also saddened by the occurrence of a situation that both doctors and patients wish to avoid.
Firstly, the scrotum has a rich vascular supply, and whether or not surgery is performed, it is easy to experience bleeding with even slight exertion or trauma.
Therefore, during surgery, doctors repeatedly confirm that all blood vessels are adequately cauterized.
After surgery on the scrotum or any other area, there will inevitably be some damaged blood vessels, and if blood pressure rises even slightly, it can lead to vessel rupture.
Additionally, the scrotum itself is a somewhat elastic organ that can hold a significant amount of blood; if a patient is very tolerant, the scrotum can accommodate over 1000cc of blood.
After surgery, ice packs can be used to reduce swelling and help stop minor bleeding.
I personally recommend applying ice for 2-3 days post-surgery.
For detailed surgical information, you can visit the website of the Taiwan Urological Association and download the "Surgical Instructions" document, which contains important notes regarding urological surgeries.
http://www.tua.org.tw/form/index_01.asp
As for your questions, here are my brief responses:
1.
Regarding whether the surgery was performed correctly, I believe the chances of a successful surgery are very high.
This type of surgery is quite simple, and the failure rate is very low.
The likelihood of complications is also not high.
However, why did such unfortunate events occur? It may be due to postoperative care or fluctuations in blood pressure that led to bleeding.
Some surgeons may use vasoconstrictors during surgery to facilitate the procedure, and after the vasoconstrictor metabolizes, small blood vessels may dilate and cause bleeding.
Accidental impacts or other issues (such as coagulation disorders, liver cirrhosis, medications, etc.) can also lead to scrotal bleeding.
2.
Regarding the 20 cm black area: if it is not too painful, gentle heat application can be used to enhance blood circulation.
If there is no ongoing bleeding, it should completely absorb within about 2-3 months.
As for whether it will return to its original appearance, I believe that as long as there is no further bleeding or infection, the chances of recovery are quite good.
However, this depends on the circumstances of the second surgery.
3.
Was there any negligence in patient care? This is a serious question.
Whether there was negligence is not a matter of personal opinion; that would be too subjective.
It can be said that any surgery carries risks.
Did the doctor provide sufficient information before the surgery? If they did, and the surgery was conducted carefully with all precautions taken, yet complications still occurred, then from any standpoint, it should not be considered negligence on the part of the physician.
In other words, when such situations arise, did the doctor inform you beforehand, or did you dismiss the information as irrelevant, thinking it would not happen? The issue of whether adequate information was provided before the surgery is very important.
Conversely, if the doctor failed to fulfill their duty to inform, then the patient can indeed question whether the doctor adequately disclosed the potential downsides of the surgery, which could be seen as "misleading" the patient or encouraging them to undergo the procedure (these statements may be too harsh, but I don't know how to describe this attitude appropriately; the key point is the thorough disclosure of both positive and negative information to the patient.
If the patient is fully informed and still chooses to proceed with the surgery, then the doctor should not be categorized as negligent).
If, unfortunately, complications that were previously disclosed occur post-surgery, did the doctor make every effort to resolve them? In your case, the doctor promptly opened an emergency surgery, which should be beyond question.

Doctors are human, and the expectation that they should never make mistakes is unrealistic.
Holding them to the highest standards can create conflicts in the doctor-patient relationship.
If complications from surgery are deemed unavoidable, each case should be thoroughly reviewed rather than criticized.
This is how medicine progresses.
Otherwise, when even minor issues arise, the tendency is to deny any connection to the surgery and blame the patient (for not taking care of themselves, having poor health, etc.).
If the patient does not believe this, then providing them with information (rather than disclosing everything before the surgery and allowing them to decide whether to proceed) often leads to a shattered perception of doctors as infallible, making it hard for patients to accept that surgeries carry risks, and they may unjustly believe that the doctor made a mistake during the procedure.
This mindset does not benefit the understanding of diseases or surgical complications.
Here are my suggestions:
1.
To prevent wound infection, I personally recommend administering antibiotics as a precaution (some doctors believe that the blood circulation in the scrotum is very good and that antibiotics are unnecessary).
2.
If heat application does not cause increased pain, I suggest applying heat several times a day for about 5-10 minutes each time.
Ensure it is not too hot to avoid burns; if pain worsens during heat application, switch to ice.
3.
Avoid prolonged standing or other activities that increase pressure on the scrotum.
If bleeding is suspected, stop heat application immediately and seek medical attention.
4.
Regarding whether there was negligence in care or medical treatment, it is best not to dwell on this at this stage, as it may affect future communication and trust.
5.
If you have doubts about the surgery or no longer trust this physician, I recommend seeking treatment and consultation from another specialist.
Otherwise, treatment under such circumstances usually does not yield good results, and you may have concerns about the subsequent treatment methods of the surgical physician, potentially leading to non-compliance and delaying your condition.
6.
I emphasize again, if you have doubts, do not force yourself to continue seeing this doctor; seek assistance from another specialist promptly.
Taiwan's Ministry of Health and Welfare, Taitung Hospital, cares about your urological health.

Director: Hsu Wei-Kai
If you have any concerns regarding this response, please feel free to continue the discussion.

Reply Date: 2010/04/11

More Info

Post-vasectomy complications can be concerning and often lead to significant discomfort and anxiety for patients and their families. Based on your description, it appears that your husband experienced a series of unfortunate events following his vasectomy, which resulted in severe pain and swelling in the scrotal area. Let’s address your questions and provide some insights into the situation.

1. Could the doctor have performed the surgery improperly?
While it is difficult to definitively say whether the surgery was performed incorrectly without a thorough examination, complications such as hematomas (internal bleeding) can occur even with a technically sound procedure. Vasectomy is generally a safe outpatient procedure, but complications can arise due to factors such as individual anatomy, the presence of underlying conditions, or even the body’s response to surgery. If a hematoma develops, it can cause significant swelling and pain, as blood collects in the tissue surrounding the surgical site. This is not necessarily indicative of surgical error but rather a potential complication that can occur.

2. Will the swelling and discoloration return to normal?
The swelling and discoloration you described, particularly the large black area, suggest a significant hematoma. In most cases, hematomas will gradually resolve as the body reabsorbs the blood. This process can take days to weeks, depending on the size of the hematoma and the individual's healing response. It is essential to monitor the area for any signs of infection, such as increased redness, warmth, or discharge, which would require medical attention. Over time, the discoloration should fade, and the swelling should decrease, but it is crucial to follow up with a healthcare provider to ensure proper healing.

3. Was there negligence in patient care?
The lack of postoperative follow-up and the initial oversight in prescribing pain medication could be viewed as a lapse in patient care. After any surgical procedure, especially one that has complications, it is standard practice for healthcare providers to ensure that patients have adequate pain management and follow-up instructions. If your husband is experiencing significant pain and difficulty with mobility, it is advisable to seek further medical evaluation. A follow-up appointment with the urologist or a visit to another healthcare provider may be necessary to assess the situation and provide appropriate treatment.

Additional Considerations
- Pain Management: It is crucial for your husband to have adequate pain control. If the prescribed pain medication is insufficient, he should communicate this to his healthcare provider. There are various options available, including stronger analgesics or alternative pain management strategies.

- Activity Restrictions: It is essential for your husband to avoid strenuous activities, heavy lifting, or prolonged standing until he has fully recovered. This will help prevent further complications and allow the area to heal properly.

- Monitoring for Complications: Keep an eye on the surgical site for any signs of infection or worsening symptoms. If the pain intensifies, or if there are any concerning changes, it is vital to seek immediate medical attention.

- Follow-Up Care: Encourage your husband to schedule a follow-up appointment with his urologist or another healthcare provider to discuss his symptoms and ensure that he is healing appropriately. This visit can also address any concerns about the surgical outcome and recovery process.

In conclusion, while complications after a vasectomy can be distressing, many patients recover well with appropriate care and monitoring. It is essential to maintain open communication with healthcare providers and advocate for your husband’s health and comfort during this recovery period.

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