Abnormal bruising on the penis 3 days after a vasectomy

This image originally appeared as part of this site’s “Ask a Doctor” section. The following question is from a real vasectomy patient, and the answer comes from Dr. Edward Karpman.

Contributor’s question

Thank you for taking the time to look at my question. Today is Wednesday. Monday at 3:30 PM I had vasectomy. I am still experiencing a high level of discomfort which I think was expected but my concern is the location and specific pattern of my bruising. The bruising seems to follow straight up the path of my urethra. I just would like to know if there is cause for concern. I have attached a photo of the bruising on the penis. The photo was taken a few minutes ago, and thus, is the most recent.

Extensive bruising up the penis 3 days after a vasectomy
Extensive bruising up the penis 3 days after a vasectomy

Dr. Karpman’s reply

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.

Many thanks to our contributor for submitting these pictures and allowing us to use them.

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