Ischemic testicular necrosis following vasectomy: rare and typical complications of an outpatient procedure

Ischemic testicular necrosis following vasectomy: rare and typical complications of an outpatient procedure

Urologe A. 2011 Oct;50(10):1306-10. doi: 10.1007/s00120-011-2634-3.

PMID: 21845426

Abteilung für Urologie, Kinderurologie und Uro-Onkologie, St. Josef-Hospital, Hospitalstraße 45, 53840, Troisdorf, Deutschland. norbert.rolfes@josef-hospital.de

Abstract

Taking the clinical case of a patient who developed unilateral testicular necrosis following vasectomy as a starting point, the early and late complications of this procedure are described based on a literature review.In the USA 7% of all men undergo vasectomy, as compared to 2% in Germany. Early postoperative complications include bleeding/hematoma (0.5-18%), infection (0.3-32.9%), epididymitis (0.4-6.1%), granuloma (0.07-90%), and rare complications such as vas deferens abscess, vesicular gland abscess, vasovenous fistula, testicular necrosis, arteriovenous fistula, pulmonary embolism, endocarditis, scrotal skin necrosis and Fournier’s disease which mostly have been reported in the form of case reports. Late complications are chronic pain (0.5-18%), pain during sex (2.9%), hydrocele (0-4%) as well as spermatocele (1.6%). There is a failure rate of 4.3-16% as concluded from the number of patients with nonmotile sperm in the post-vasectomy semen analysis. The postoperative paternity rate is 0-4%.Bilateral vasectomy is a secure way of contraception; perioperative and late complications are on an average rare, however, with a range up to 90%. In individual cases severe complications occur, which should be detected at an early stage. Therefore a close follow-up should be maintained after this outpatient procedure. One should ask for risk factors of endocarditis or thrombosis preoperatively. The patient should be informed of the possible loss of a testicle because of the severity of this complication. Postoperative semen analysis is obligatory.

Vic’s notes:

*sigh* Do I really have to do your job for you guys? The occurance rate for post-vasectomy chronic pain is in table 2 on the fourth page. The lower bound rate is actually 3%, not 0.5%. The median rate reported was 8.4%.

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