Post-Operative Hematoma in Scrotum: When to Seek Medical Attention?

Postoperative hematoma of the scrotum?

Dear Doctor,
I underwent a skin graft surgery for phimosis at a private urology clinic ten days ago, with the donor site being my scrotum.
Seven days post-operation, the doctor squeezed out a significant amount of blood clots and mentioned that if there was still swelling during my follow-up appointment next week, they would need to aspirate it.
Now, ten days post-surgery, my scrotum remains swollen with no signs of reduction.
Should I go to the hospital for further management? Is there a risk of testicular atrophy due to the pressure from the hematoma? Could aspiration of the scrotum increase the risk of infection? Initially, the clinic doctor told me that the swelling would subside within three to five days, and since the wound from the scrotal skin graft is easier to care for than one from the abdomen, they recommended using the scrotal area.
The swelling is now affecting my work, which is quite distressing.
Wishing you peace and joy.

Xiao Xie, 30~39 year old female. Ask Date: 2013/09/13

Dr. Xu Weikai reply Urology

Hello, if the scrotum is very swollen, a follow-up appointment for treatment is necessary.
In severe cases, surgery may be required for hemostasis and debridement.
Scrotal swelling, unless extremely severe, generally does not lead to testicular atrophy.
Aspiration of blood clots can lead to infection if sterilization is not thorough.
Whether hospitalization is needed depends on the clinical physician's judgment.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only be used as a reference; if necessary, you should seek medical care at a healthcare facility.
This message is from Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2013/09/13

More Info

Post-operative hematoma in the scrotum can be a concerning complication following surgical procedures, such as the skin grafting you underwent. Given your situation, it is important to understand when to seek medical attention and the potential implications of a persistent hematoma.

Firstly, it is not uncommon for some swelling to occur after surgery, especially in delicate areas like the scrotum. However, if the swelling persists beyond the expected timeframe—typically around three to five days post-surgery—it may indicate that there is a hematoma that is not resolving on its own. In your case, since you are now ten days post-operative and the swelling has not subsided, it is advisable to seek medical attention. Persistent swelling can lead to complications such as infection or pressure on surrounding structures, including the testicles.

Regarding your concern about testicular atrophy due to pressure from the hematoma, it is possible for prolonged pressure to affect the blood supply to the testicles, which could lead to atrophy. The testicles require a healthy blood supply to maintain their function, and any obstruction or pressure can potentially compromise this. Therefore, addressing the hematoma promptly is crucial to prevent any long-term complications.

As for the risk of infection associated with aspiration (draining) of the hematoma, there is indeed a risk. Any procedure that breaks the skin barrier carries the potential for introducing bacteria, which could lead to an infection. However, if the hematoma is large and causing significant discomfort or complications, the benefits of drainage may outweigh the risks. It is essential that this procedure be performed in a sterile environment, ideally in a hospital or surgical center, to minimize the risk of infection.

In summary, given the persistence of your symptoms and the impact on your daily life, it is highly recommended that you return to your healthcare provider or seek a urologist's opinion as soon as possible. They may perform an ultrasound to assess the hematoma's size and determine the best course of action, which may include aspiration or further intervention if necessary. Early intervention can help alleviate discomfort and prevent complications, ensuring a smoother recovery process.

In the meantime, you can manage discomfort with over-the-counter pain relief, but avoid any activities that may exacerbate the swelling or put additional strain on the area. Resting and elevating the scrotum may also help reduce swelling. However, these measures are not substitutes for professional medical evaluation and treatment.

Wishing you a speedy recovery and relief from your symptoms.

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