The Rate of Hydrocele Perforation During Vasectomy

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Date: June 2000
From: Journal of Family Practice(Vol. 49, Issue 6)
Publisher: Jobson Medical Information LLC
Document Type: Article
Length: 1,958 words

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Is Perforation Dangerous?

* BACKGROUND Hydroceles are not uncommon, are often occult, and may be associated with an inguinal hernia. The rate of hydrocele perforation during elective vasectomy has not been reported in the medical literature. Our objective was to estimate the frequency and consequences of hydrocele perforation incidental to vasectomy.

* METHODS We retrospectively reviewed data from a series of patients undergoing vasectomy using the no-scalpel technique for the incidence of complications. A supplementary chart review was done to determine preoperative conditions, and telephone contacts were made if needed to assess later morbidity.

* RESULTS We noted 7 perforations in 150 vasectomies. Only one patient had a hydrocele documented preoperatively. Three had histories of inguinal hernia and herniorrhaphy. Five patients had evidence of minor swelling early on, but none had additional morbidity or long-term associated complications.

* CONCLUSIONS This small case series of vasectomies had a 4.7% incidence rate of perforated small or occult hydroceles. Physicians should be aware of this potentially alarming but apparently minor phenomenon that may accompany vasectomy.

* KEYWORDS Hydrocele; vasectomy; perforation [non-MESH]. (J Fam Pract 2000; 49:537-540)

Vasectomy is a common procedure in the United States with an estimated 500,000 performed annually for elective sterilization.[1,2] Major reported complications are unusual (virtually no mortality is reported),[3] but may include large hematomas, serious infections, primary surgical failure to close the vas, and late failure presumably due to vasal recanalization. Most complications are minor, including small hematomas, mild infection, minor bleeding, sperm granuloma, epididymitis, and orchitis.[4]

Perforation of a hydrocele that was not evident preoperatively is not rare, according to personal communication with experienced vasectomists. However, a MEDLINE search of the literature from 1959 to 1999 failed to find mention of this phenomenon.

We describe a series of patients who had hydroceles perforated acutely during a no-scalpel vasectomy. Clinical and telephone follow-up was used to track outcomes of this occurrence.

METHODS

Study Population and Data

Patients were referred by a variety of community and academic practicing physicians, by institutional referral contacts, self-referred, or referred by physicians in our residency clinic practice. One hundred fifty consecutive patients who underwent no-scalpel vasectomy between March 1992 and September 1998 were concurrently listed in a computerized database. Patient identifiers, complications, and follow-up were among the data recorded.

Clinical Intervention

All patients had preoperative assessment, including genital examinations by one of the authors (J.S.), and gave informed consent. Local anesthesia of the scrotum and bilateral perivasal block were used in all cases, as was the no-scalpel method of Li to access each vas.[5] The abdominal lumen of the vas was closed to approximately 1-centimeter depth with thermal cautery (through the first 29 cases), after which a bipolar electrical cautery source was used. A fascial interposition was created and closed using 4-0 chromic suture (through the first 20 cases, including hydrocele perforation case 1) after which medium-sized surgical clips were used. The single scrotal puncture was not sutured and was coated with triple antibiotic ointment covered with...

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Gale Document Number: GALE|A65571130