The submitted picture represents an incision 2 days after a vasectomy procedure with a single midline incision. There is minimal bruising and swelling surrounding the wound. The dark areas represent some skin that has been strangulated by the sutures used to close the incision. There appear to be 4-5 temporary sutures. Everything appears to be healing as expected for a man after a vasectomy performed with a single midline incision two days after the procedure. The single midline incision sounds attractive to prospective patients, but the reality is that a single incision that requires 4-5 sutures to close is much more invasive than two separate incisions requiring zero to one suture to close. A comparison of photos from previous posts using the 2 incision technique will help with understanding the differences between the two approaches.

Dr. Karpman’s website

I would like to ask a question if I may:- Is the amount of bruising something I should be worried about?

These pictures represent some greater than expected bruising after vasectomy. The bruising extends to the base of the penis and across both hemiscrotal areas. There seems to be minimal swelling which would suggest that the bruising is due to some bleeding in the skin layer and not a hematoma in the scrotum. The second picture demonstrates one of the incision sites that appears to be healing appropriately.

The following pictures have been sent in as updates:-

Day 7

Day 9

Day 9 with incision site marked

Day 11

Day 13

Day 16 close up on the scar

All of the pictures above are available with full sized image here.

Dr. Karpman’s website

The midline incision for performing vasectomy is one approach to this surgery. A small amount of swelling can develop at the incision and beneath the suture used to close the incision. The incision does demonstrate a small area of scrotum that is congested under the suture line. This post-operative picture represents appropriate swelling and bruising after a vasectomy.

Dr. Karpman’s website

I have attached 2 pictures one of the hernia incision, which it looks like he used a previous scar from an earlier surgery. You can see swelling below the incision. The second picture is of the cut mentioned in the question above.

 

Sometimes, surgeons will offer to perform a vasectomy through the same incision as the hernia repair. This is a convenient approach for vasectomy. However, the patient should be informed that performing a vasectomy reversal is significantly more difficult in the groin than in the scrotum as it is normally performed and this might limit a patients options in the future. I have never heard of a vasectomy being performed through a penile incision like the one pictured in this case. Since there is an incision over the left hemi-scrotum and the vas deferens is easily accessible through the right hernia incision, I can’t explain what the additional incision was used for. Perhaps asking the surgeon who performed the surgery the reason for this incision and posting a follow-up message would be useful.

Bruising after a vasectomy can extend in any direction from the vasectomy incision site. In this case we see the bruising tracking up the penis along the course of the urethra. Urethral damage has been reported at the time of vasectomy in a few rare instances and this is more likely to happen with a midline incision as compared to bilateral incisions. A urine analysis should be performed to rule out microscopic blood in the urine if no gross blood is seen when urinating. Any blood in the urine should be further evaluated with specialized x-ray tests of the urethra and possibly urethroscopy (endoscopic visualization of the urethra). Blood in the urine would suggest a urethral injury. The appearance of bruising in this picture suggests damage to at least the corpus spongiosum, the vascular structure surrounding the urethra. This can occur without damage to the underlying urethral lumen.

Thank you so much – we really need your help…..

Scrotal hematoma can be a complication of ANY scrotal surgery and is not just limited to vasectomy procedures. In fact, the more involved the scrotal surgery, the higher the risk of developing a scrotal hematoma. Meticulous care to control all possible bleeding sites at the time of surgery is necessary to prevent scrotal hematomas. Blood from a scrotal hematoma can track up the abdominal wall or down into the perineum. Blood tracking into the perineum will cause a characteristic butterfly pattern as seen in these pictures. After two weeks, there is nothing surgical that can be done to minimize the bruising. In fact, bruising at this point represents old blood that has already begun to degrade and will go through a spectrum of color changes like any other bruise. Since the active bleeding most likely has stopped, the best course of action would be to wait for the hematoma and bruising to resolve which can take several months. It is difficult to say if any harm to the vasectomy reversal will come from this hematoma. The hematoma will inevitably cause some scarring in the scrotum. The extent of the scarring and the damage due to the scarring is unpredictable. The best indicator of the success of the surgery will be based on the results of the semen analysis.

Firstly, one of Dr. Karpman’s patients has kindly consented to us posting pictures of his vasectomy incisions taken just after the procedure.

Secondly, we have pictures of a midline incision vasectomy taken on day 1 just after the vasectomy, and the subsequent healing and bruising on day 4.

Lastly, we have pictures of vasectomy scars taken some years after vasectomy. One set is a bilateral vasectomy with photo’s taken 10 years afterwards, the other is a midline incision vasectomy with photo’s 7 years afterwards.

Thanks to the contributors, and if you’d like to join them in having your photo’s on the web, then please visit this page for more information on what we are looking for, some useful photographic tips and the email address to send them to.