Unexpected swelling after a vasectomy? What is a scrotal hematoma?

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If you look closely you’ll see small blood vessels along the side of the severed vas deferens. Above the the suture (the vas deferens and the suture have been enlarged about ten times) you’ll note that the blood vessels have been blanched by having been fulgurated. Below the suture (looks like a small brown rope) the blood vessels are red. These blood vessels are tiny and sometimes not seen by the urologist and then after the vas deferens retract back into the scrotum-they ooze. Like a small oil leak, the blood continues to leak and accumulate until the surrounding tissues stop it. The result is a hematoma. Hematomas can vary in size depending on the size of the vessels and the amount of blood that leaks before the tamponade (pressue that stops bleeding)  of the surrounding tissues stop it.

Hematomas are not an infection and are not dangerous but both the patient and the urologist wish that it doesn’t happen after a vasectomy. The problem is that they stay around for weeks because it takes time for the body to absorb it. For the most part it is preventable if the urologist is careful to completely occlude these vessels around the vas deferens.

When I do a vasectomy I remove a section and then fulgurate both sides of the vas deferens. This in the majority of cases will handle the small vessels along side the tubes but it doesn’t always. In addition to the above, I place a suture at the very base of of the vas deferens that is beyond where the vas has been dissected thus preventing inadvertent bleeding beyond where the vas has been fulgurated. (These are the red vessels you see near the clamps. The suture is placed and tied just beyond the clamp.)

So…when you talk to people about your upcoming vasectomy and they tell you that they had a lot of swelling of the scrotum that was black and blue…they had a hematoma and in most cases it could have been prevented. Some how attention to these pesky little vessels that travel along side the vas and cause hematomas…were not appropriately given the respect they deserve.

Did you know that if a surgeon needed to or inadvertently cut the testicular artery, that the vasal artery is sufficient enough to keep the testicles alive and viable?

This is why hematomas can be substantial and cause a significant post vasectomy issue.

“Respect thy vessels that accompany the vas deferens!”

 

 

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