This case involves a man who went in for vasectomy and returned the following day with testicular pain. The presumptive diagnosis was torsion so he was rushed into surgery. During surgery, doctors found an injury to the epididymis as well as a surgical clip next to the epididymis that was compromising the blood vessels. The clip was removed, but blood flow did not return after 30 minutes. Subsequently, his testicle had to be removed.

I perform vasectomy and vasectomy reversals weekly. The best way to prevent vascular injury is correct identification of the anatomy and to dissect the vasal artery off the vas prior to dividing/clipping the vas. Epididymal injury is very uncommon and can be caused by performing the vasectomy too proximal to the testis. I have reviewed cases for vascular complication requiring orchiectomy after vasectomy in the past.

1. What tools/techniques are used to prevent vascular injury while clipping the vas?

2. What are the most common causes of injury to the epididymis during this procedure?

3. Have you seen this complication before or reviewed a similar case?

MD, University of Vermont College of Medicine

Residency, Urology, George Washington University Hospital

Fellowship, Male Reproductive Medicine and Microsurgery, Baylor College of Medicine

Member, Society of Male Reproduction and Urology

Published: 10+ peer-reviewed articles and 6 book chapters

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This board-certified expert holds major positions as a Urologist, Male Fertility specialist, and Men's Health physician. He received his BS in Biology and Chemistry from Emory University and his MD from the University of Vermont School of Medicine. The expert completed his Residency in Urology at George Washington University and a Fellowship in Male Reproductive Medicine and Microsurgery at Baylor. He is a member of numerous professional societies has published more than 10 peer-reviewed articles and 6 book chapters. The expert formerly served as an Assistant Professor of Surgery at the University of California, San Diego. He currently serves as an Associate Professor of Surgery at a Medical School in southern California, and as Director of Male Fertility and Men's Health at an affiliated medical center.

Surgical Clip Left After Vasectomy Impedes Blood Flow to Testicle

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