Andrology, genital and scrotal surgery
Common penile, scrotal, fertility and prosthetic procedures.
Adult acquired buried penis reconstruction
Major wound infection or dehiscence
Large moist wounds, comorbidity and lymphatic leakage can compromise healing.
Applies to: All variantsGraft loss or skin necrosis
Haematoma, shear, infection or poor bed vascularity can prevent graft take.
Applies to: Penile skin excision and grafting · Composite genital reconstructionBleeding, seroma or lymphatic leak
Broad suprapubic and genital dissection creates large raw surfaces.
Applies to: All variantsUrethral or neurovascular injury
Distorted anatomy and chronic inflammation can obscure the urethra and dorsal structures.
Applies to: All variantsRe-burying, contracture or contour problem
Scar contraction, residual tissue or failed fixation can recreate concealment.
Applies to: All variantsAltered sensation, erectile or sexual-function difficulty
Extensive skin and base reconstruction can change sensation, mechanics and sexual confidence.
Applies to: All variantsDonor-site morbidity
Graft harvest adds pain, delayed healing, infection and scarring at a second site.
Applies to: Penile skin excision and graftingCircumcision, preputioplasty and dorsal slit
Bleeding or haematoma
Frenular or dorsal-vessel bleeding can collect beneath a tight dressing or skin closure.
Applies to: All variantsGlans or urethral injury
Blind or poorly controlled division can injure the glans, meatus or urethra.
Applies to: All variantsInfection or wound separation
Contamination, haematoma or tissue compromise can disrupt healing.
Applies to: All variantsSkin excess, deficiency or cosmetic asymmetry
Tissue planning affects later contour, tethering and satisfaction.
Applies to: All variantsMeatal stenosis or urinary-stream change
Meatal inflammation or scarring may narrow the outlet, particularly in susceptible children.
Applies to: Sleeve or dorsal-slit circumcisionRecurrent phimosis
A foreskin-preserving or temporising release can re-scar and may later need definitive treatment.
Applies to: Preputioplasty · Emergency dorsal slitEpididymal cyst excision and epididymal surgery
Bleeding, haematoma or infection
Scrotal bleeding can lead to pain, swelling and secondary infection.
Applies to: All variantsTesticular vascular injury or atrophy
Dissection close to testicular vessels can compromise perfusion.
Applies to: All variantsObstructive fertility impairment
Epididymal interruption can impair sperm transport, particularly with bilateral disease or a compromised opposite side.
Applies to: All variantsPersistent or worsened scrotal pain
Pain may arise from another source or persist despite removal of the visible lesion.
Applies to: All variantsCyst recurrence or new cyst formation
Residual cyst lining or disease elsewhere in the epididymis can produce recurrent swelling.
Applies to: Epididymal cyst excisionHydrocele surgery
Scrotal bleeding or haematoma
The dependent and compliant scrotum can conceal substantial postoperative bleeding.
Applies to: All variantsInfection or wound breakdown
Haematoma and oedema increase the risk of superficial or deeper infection.
Applies to: All variantsTesticular, epididymal or vas injury
Sac dissection can damage reproductive structures or compromise testicular blood supply.
Applies to: All variantsChronic scrotal pain or altered sensation
Nerve irritation, scarring or epididymal injury can cause persistent symptoms.
Applies to: All variantsRecurrent hydrocele or persistent swelling
Residual sac, continuing communication or lymphatic swelling can mimic or cause recurrence.
Applies to: All variantsSclerosant-related inflammation or tissue injury
Extravasation or an intense local reaction is specific to the percutaneous pathway.
Applies to: Aspiration and sclerotherapyPenile prosthesis implantation, revision and salvage
Corporal, urethral or visceral perforation
Dilatation, cylinder passage or reservoir placement can breach the corporal bodies, urethra, bladder, bowel or vascular structures.
Applies to: All variantsProsthesis infection
Infection can involve any component and may necessitate explantation or a specialist salvage strategy.
Applies to: All variantsErosion or extrusion
Cylinders, pump or rods can erode into urethra or through compromised skin.
Applies to: All variantsMechanical failure or fluid leak
Pump, tubing, reservoir or cylinder failure can prevent inflation or deflation.
Applies to: Three-piece inflatable prosthesis · Two-piece inflatable prosthesis · Revision, explantation or salvageCylinder malposition, crossover or deformity
Incorrect position or later migration can cause pain, poor rigidity, asymmetry or impaired penetration.
Applies to: All variantsGlans ischaemia or distal tissue compromise
Vascularly fragile tissue may become ischaemic after extensive dissection or oversizing.
Applies to: All variantsPersistent pain or dissatisfaction
Pain, perceived penile shortening, altered sensation or unmet expectations can remain despite a functioning device.
Applies to: All variantsSurgery for Peyronie disease and complex penile curvature
Neurovascular or urethral injury
Mobilisation and tunical incision can injure dorsal nerves, vessels or the urethra.
Applies to: All variantsBleeding, haematoma or wound infection
Penile dissection creates a confined space where bleeding and infection can compromise healing.
Applies to: All variantsRecurrent or residual curvature
Straightening can be incomplete or deformity can recur as tissues heal.
Applies to: All variantsPenile shortening, narrowing or altered sensation
Changes in dimensions and sensation vary by technique and should be distinguished from erectile function.
Applies to: All variantsNew or worsened erectile dysfunction
Tunical, neurovascular and veno-occlusive changes can impair erections, particularly after grafting.
Applies to: All variantsGraft contraction, bulge or aneurysmal change
A substitution graft can contract or stretch and change penile contour.
Applies to: Plaque incision or partial excision with graftDevice infection, erosion or failure
The prosthesis-based pathway adds the full set of implant-specific complications.
Applies to: Penile prosthesis with modelling or incisionSurgical sperm retrieval
Scrotal bleeding or intratesticular haematoma
Needle or open tissue sampling can cause local bleeding and pressure-related pain.
Applies to: All variantsInfection
Percutaneous and open access can introduce superficial, epididymal or testicular infection.
Applies to: All variantsTesticular tissue loss, atrophy or endocrine impact
Extensive sampling or vascular injury can reduce already limited testicular function.
Applies to: Conventional TESE · Micro-TESEPersistent pain or altered sensation
Scarring, inflammation or nerve injury may cause chronic symptoms.
Applies to: All variantsNo viable sperm retrieved
Retrieval can be technically complete without finding sperm suitable for planned treatment.
Applies to: All variantsLaboratory or chain-of-custody failure
Specimen identification, handling and coordination are safety-critical parts of the operative pathway.
Applies to: All variantsTesticular prosthesis implantation and revision
Infection
Prosthesis infection may require removal and delayed reconsideration.
Applies to: All variantsExtrusion or skin erosion
A tight pocket, poor tissue or infection can expose the implant.
Applies to: All variantsHaematoma or wound breakdown
Scrotal bleeding and tension can compromise closure.
Applies to: All variantsMigration, high position or rotation
Pocket and fixation problems can leave an asymmetric or uncomfortable implant.
Applies to: All variantsPersistent pain or dissatisfaction with size/feel
A technically intact implant may not meet cosmetic or tactile expectations.
Applies to: All variantsDelay to cancer treatment or surveillance concern
Implant-related morbidity must not obscure pathology follow-up or delay indicated oncological care.
Applies to: Immediate implantationVaricocele treatment
Testicular artery injury and atrophy
Loss of arterial supply can cause ischaemic pain and later testicular volume loss.
Applies to: All variantsHydrocele or lymphatic swelling
Lymphatic interruption can lead to fluid accumulation around the testis.
Applies to: All variantsPersistent or recurrent varicocele
Missed collaterals, recanalisation or alternative venous drainage can preserve reflux.
Applies to: All variantsBleeding, infection or chronic pain
Access-site morbidity varies across inguinal, abdominal and venous routes.
Applies to: All variantsCoil migration, venous thrombosis or contrast-related event
The endovascular route adds embolic-device, access-vessel and contrast-specific complications.
Applies to: Radiological embolisationIntra-abdominal organ or vessel injury
Port and retroperitoneal dissection add abdominal access risks.
Applies to: Laparoscopic ligationVasectomy
Bleeding or scrotal haematoma
Cord or skin-vessel bleeding can cause painful swelling and delayed recovery.
Applies to: All variantsWound or epididymal infection
Local infection may involve the skin, vas or epididymis.
Applies to: All variantsChronic post-vasectomy scrotal pain
Persistent pain may relate to congestion, nerve injury, granuloma or other scrotal pathology.
Applies to: All variantsSperm granuloma
Extravasated sperm can produce a palpable inflammatory nodule that may be painful.
Applies to: All variantsEarly technical failure or late recanalisation
Persistent or renewed vas continuity can result in sperm in semen and unintended pregnancy.
Applies to: All variantsWrong-structure or unilateral procedure
Failure to identify and occlude both true vasa produces immediate procedural failure.
Applies to: All variantsVasectomy reversal
Bleeding, haematoma or infection
Scrotal or inguinal bleeding can compromise microsurgical reconstruction and recovery.
Applies to: All variantsTesticular vascular injury
Cord dissection can threaten arterial supply, particularly after previous surgery.
Applies to: All variantsAnastomotic leak or obstruction
A non-watertight or technically narrowed join may fail before stable patency develops.
Applies to: All variantsLate re-stenosis after initial patency
Scar can close an initially patent reconstruction.
Applies to: All variantsPersistent infertility despite patency
Restoration of sperm to semen does not guarantee pregnancy because of male, female or couple factors.
Applies to: All variantsChronic scrotal pain
Scarring, nerve injury or ongoing obstruction can produce persistent pain.
Applies to: All variants