Iatrogenic Urethral Injury During Vasectomy

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Patrick O. Malley MB, BCh, BAO,AFRCSI, MmedSc (Urol)
Specialist Registrar in Urology
Department of Urology
Morriston Hospital

Address:
Swansea
United Kingdom

Robert Skyrme MB, FRCS
Specialist Registrar in Urology
Department of Urology
Morriston Hospital

Address:
Swansea
United Kingdom

Keith Vaughton MB, FRCS
Consultant Urologist
Department of Urology
Morriston Hospital

Address:
Swansea
United Kingdom

Citation: P. O. Malley, R. Skyrme & K. Vaughton : Iatrogenic Urethral Injury During Vasectomy . The Internet Journal of Urology. 2005 Volume 2 Number 2

Keywords: vasectomy | complications | iatrogenic

Abstract

Complications during vasectomy are extremely rare especially urethral injuries, which to our knowledge, are previously unreported. We present a case of iatrogenic urethral injury necessitating reconstructive corrective surgery, highlighting the potentially serious complications from this simple surgical procedure.

Case Report

A 35-year-old man presented for an elective vasectomy under local anaesthetic at a separate institution. During attempted ligation of the right vas deferens intraoperative bleeding and patient discomfort necessitated conversion to a general anaesthetic. Vicryl (polyglactin) haemostatic sutures were placed in the right hemiscrotum. Twelve hours post operatively the patient developed acute urinary retention. Urethral catheterisation was not possible and a suprapubic catheter was inserted. Urethroscopy revealed occlusion of the urethra at the peno-scrotal junction by visible suture material.

Following endoscopic division of the suture with a urethrotomy knife it was still not possible to access the posterior urethra due to urethral tissue damage and luminal occlusion. Retrograde urethrograms and urethroscopy three months later confirmed occlusion of the urethra at the penoscrotal junction and the patient was referred for further management. Four months following the vasectomy a buccal mucosal inlay graft urethroplasty was performed.

A subsequent urethrogram six weeks following urethroplasty revealed satisfactory urethral calibre with no anastomotic leak. The patient is now voiding normally and is symptom free seven months following the urethroplasty.

Figure 1: Endoscopic view of the suture material traversing the urethral lumen.

Figure 2: Subsequent repair of the urethral stricture using a buccal mucosal inlay graft

Discussion

Following an extensive literature review no other reported cases of iatrogenic urethral injury during vasectomy were found. Numerous articles have highlighted the complications of vasectomy¹,²,³ with no reference to urethral injury. This case highlights the potentially serious complications of a minor surgical procedure.

References

1. T.Philp,J.Guillebaud,D.Budd.(1984)Complicatations of vasectomy:Review of 16000 patients.BJU 56,745-748. (s)

2. J.M.Choe,A.K.Kirkemo.(1996)Questionnaire based outcomes study of nononcological post-vasectomy complicatations.J Urol.155,1284-6. (s)

3. C Gingell,D Crosby,R Carroll.(2001)Review of the complications and medicolegal implications of vasectomy.Postgrad Med J;77:656-659. (s)

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