Question from a doctor regarding incidence of testicular loss when vasectomy is performed after excision of a cord lipoma
Aug 13th 2008adminGeneral questions
From Andrew:-
I am a second year surgical resident, and the question was posed to me during an inguinal hernia repair: What is the incidence of testicular loss when vasectomy is performed after excision of a cord lipoma? I have looked in textbooks, medline, and online for hours, and have yet to find an answer. Do you know this statistic? Thank you for your assistance.
The actual answer is unknown. However, if done correctly, a cord lipoma and vasectomy should not cause testicular atrophy. The blood supply to the testicle is threefold: testicular artery, vasal artery and cremasteric artery. The testicular artery is the dominant blood supply and even ligating or injuring this artery only results in testicular atrophy in 10% of cases. Removal of a cord lipoma should not damage any of the blood supply if it is done correctly. Many vasectomy surgeon will compromise the vasal artery blood supply during a vasectomy. Since this is not the dominant blood supply to the testicle it is inconsequential to testicular health.
Andrew Coble, M.D. on 24 Aug 2008 at 8:56 pm #
I appreciate your answers; however, the point made by my attending was not about the blood supply, rather the venous drainage. If the pampinoform vessels are disrupted during lipoma excision, and then the vas is ligated, how likely is this to cause testicular vascular congestion and possible loss? Sorry to bother you again, but I am very interested in your reply.
Thanks
Andrew L. Coble, M.D.
Edward Karpman, M.D. on 25 Aug 2008 at 12:58 am #
Testicular atrophy/loss does not result from compromising the venous return. We only see testicular loss when the arterial blood supply is compromised. In fact, we routinely ligate all of the veins of the pampiniform plexus during a varicocelectomy in order to improve testicular function and health. The vasal vein is not ligated routinely, but I have done this on a few occasions due to severe dilation of the vasal vein without any resultant testicular compromise. Regardless, most of the venous return after a varicocelectomy is through the gubernacular and scrotal veins. This is why many men will develop a sclerocele (dilate superficial veins) on the scrotal skin after a varicocelectomy. We do not see any testicular atrophy after excision of a cord lipoma and vasectomy as long as the arterial blood supply is not compromised.
Edward Karpman, M.D.