Dr. J was supervising a visiting veterinary student who was completing a clinical rotation within their companion animal general practice. During the rotation, the student participated in surgeries as assistant surgeon and then lead surgeon. A 2-year-old intact male mixed breed dog presented for routine castration, also known as orchiectomy. Physical exam at presentation (as well as pre-anesthetic bloodwork, including a complete blood count) was within normal limits on the day of surgery. The patient was induced with injectable anesthetic agents and maintained on gas anesthesia uneventfully. The patient did well during surgery and immediately post-op. The patient was noted to have significant scrotal swelling and incisional bleeding prior to discharge, and an exploratory surgery was recommended and authorized by the client.
On the exploratory surgery, blood clots were removed from the scrotum and ligatures were noted to be in place, but vessels were oozing blood. Additional ligatures were placed but oozing around the surgical field continued. A source of bleeding was unable to be identified. The surgical site was closed and a pressure bandage placed. The patient was discharged to the owner with instructions for follow-up care. The following day, the dog was presented for re-check 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. A small, bleeding vessel in the subcutaneous space was identified and crushed with hemostats to control the hemorrhage. The patient was discharged with an Elizabethan collar and monitoring instructions.
The patient presented the following day for difficulty urinating, preputial swelling, and scrotal swelling. A urinary catheter was placed but it was difficult to maintain, and the patient was referred to a secondary care facility and was diagnosed with a urethral tear. A urethrostomy and scrotal ablation were performed by the subsequent veterinarian, and the owner contacted Dr. J to request a refund of fees and compensation for follow-up care. 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 urethra 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 orchiectomies 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