Objective:

To investigate a case of vasocutaneous fistula occurring 3 years after vasectomy, potentially related to retained silk ligature and chronic inflammation.

Approach:

• Patient Presentation: A 43-year-old male presented with a 2-month history of persistent whitish discharge from the left hemiscrotum following a bilateral no-scalpel vasectomy.
• Diagnostic Assessment: Clinical examination, microscopy of discharge, ultrasonography, surgical exploration, and histopathologic examination were performed to assess the sinus and its communication with the vas deferens.
• Surgical Intervention: Surgical excision of the fistulous tract and involved vasal segment was performed, with the remaining vas religated using absorbable suture.

Key Findings:

• A 2-mm sinus opening was found at the root of the left hemiscrotum, with a thickened left vas deferens beneath it.
• Microscopy revealed occasional spermatozoa and inflammatory cells in the discharge.
• Ultrasonography showed a hypoechoic tract consistent with chronic inflammation.
• Surgical exploration confirmed a fistulous tract extending to the previously ligated vasal stump, with retained silk suture embedded in fibrotic tissue.
• Histopathology demonstrated chronic inflammatory infiltrates and an adjacent fragment of vas deferens.

Interpretation:

The findings suggest that retained suture material and associated inflammation may contribute to the development of a vasocutaneous fistula post-vasectomy.

Limitations:

• The study was limited by its single-case design.
• Original ultrasound images were unavailable for independent review.
• No contemporaneous photomicrograph of sperm microscopy was available.

Conclusion:

Delayed vasocutaneous fistula should be considered in patients with persistent scrotal sinus discharge after vasectomy, especially when spermatozoa are present in the discharge.

Sources:

• BMC Urology