Dr. J was supervising a visiting veterinary student who was completing a clinical rotation within Dr. J's companion animal general practice. A 2-year-old intact male mixed breed dog presented for routine castration, and the student acted as lead surgeon for the procedure. Physical exam at presentation (as well as pre-anesthetic bloodwork, including a complete blood count) was within normal limits on the day of surgery, and the patient was induced with injectable anesthetic agents and maintained on gas anesthesia uneventfully. The patient did well during surgery and immediately post-op, but prior to discharge, Dr. J noted significant scrotal swelling and incisional bleeding prior.
An exploratory surgery was recommended and authorized by the client. During the surgery, blood clots were removed from the scrotum, and while the ligatures were noted to be in place, vessels were oozing blood. Though additional ligatures were placed, oozing around the surgical field continued and the source of the bleeding was unable to be identified. The surgical site was closed and a pressure bandage was placed. (insert discharge instructions- this sounds like Dr. J handed the dog to the client and said he's bleeding and we have no idea what's going on but here you go, good luck!). The following day, the dog presented to Dr. J for recheck and was found to have significant scrotal swelling and bruising. Upon bandage removal, the incision site began bleeding once again. A second surgical exploratory was conducted to locate the source of bleeding and a small, bleeding vessel in the subcutaneous space was identified and crushed with hemostats to control the hemorrhage. The patient was discharged once more with an Elizabethan collar and monitoring instructions.
The patient presented to Dr. J yet again on the following day for difficulty urinating, preputial swelling, and scrotal swelling. A urinary catheter was placed but was difficult to maintain, and the patient was referred to a secondary care facility that diagnosed a urethral tear. A urethrostomy and scrotal ablation were performed by the second DVM, and the patient underwent a gradual recovery. Needs filler sentence like "The client contacted Dr. J's practice and asked for the cost of the initial surgery to be waved and for their fees sustained at the secondary care facility to be reimbursed. Dr. J contacted their professional liability insurance carrier, who noted concerns about the surgical team's failure to achieve hemostasis during and following the surgical care, as well as the potential iatrogenic trauma to the urethral during one of the surgeries. The student and Dr. J both opined that the trauma likely occurred during the second exploratory surgery due to extensive tissue handling and both consented to a settlement. The insurance carrier paid $7,100 to cover the cost of additional care and surgical intervention at the secondary care facility, and Dr. J's practice agreed to waive the $2,000 cost of the initial procedure and follow up visit.
Understanding the Case
Canine castrations are routinely performed for several reasons, including population control, behavior modification, and as part of disease prevention and management. While canine orchiectomies have a relatively low incidence of post-operative complications (<15%), post-operative complications can include excessive patient attention to the surgical site (such as licking the site), scrotal hematoma, scrotal edema, granulomatous reaction at suture site, abscess, and dehiscence. In some cases, scrotal ablation may be appropriate to decrease bleeding from subcutaneous vessels within the scrotum when other attempts to prevent bleeding have failed. Urethral damage, although uncommon, may occur during surgery when vessels are not adequately differentiated from surrounding structures. Urethral damage may also occur during urinary catheter placement and manipulation.
References:
Howe, L. M.
(2015). Current perspectives on the optimal age to spay/castrate dogs and
cats. Veterinary Medicine: Research and Reports, 6,
171–180. https://doi.org/10.2147/VMRR.S53264
Scobie, C.,
Wareham, K. and Dean, R. (2026), Canine surgical castration: an evidence-based
approach to a complex issue. In Practice, 48: 108-116.
https://doi.org/10.1002/inpr.70062