Surrey and Sussex Healthcare NHS Trust

4. Mr J complains about his treatment before and after his varicocele surgery at the Trust on 20 October 2023.

5. He complains during his pre-surgery clinic appointment on 16 October 2023, the Trust did not inform him of the reduced chance of successful surgery due to previous embolisation attempts.

6. He complains the Trust exhibited a lack of aftercare and did not provide adequate instructions nor any medication to manage his pain following surgery.

7. He complains following surgery, the trust delayed recognising his haematoma (severe bruise often resulting from injury) and internal haemorrhage (bleeding inside the body).

8. Mr J says the failings in the pre-surgery clinic prevented him from making an informed decision on whether to go ahead with the surgery.

9. Mr J says the lack of adequate instructions and pain relief on discharge increased his pain and impacted on his mental health, leading to him feeling helpless and unsupported.

10. Mr J says the delay in diagnosing his haematoma and internal bleeding increased his pain and delayed him going back to work. Mr J says the pain and delayed recovery impacted on his mental health.

11. Mr J would like the Trust to acknowledge any failings with his treatment and explain why the complications following his surgery occurred. He would like a financial remedy.

12. In 2022 Mr J visited the Trust complaining of longstanding left scrotal pain which he had experienced for 13 years. He reported an increase in pain in 2022. He describes the pain as a heavy feeling, especially after strenuous activity but also standing on his feet all day due to his profession.

13. Mr J underwent two embolisation attempts on 3 August 2022 and 17 August 2022. Varicocele embolisation is a minimally invasive procedure involving blocking blood flow to the enlarged vein(s), which reduces pressure on varicoceles. Mr J’s two embolisation attempts were unsuccessful.

14. On 16 October 2023 Mr J had a pre-surgery clinic appointment. According to the Trust, he consented to all known risks and complications for varicocele surgery including the risk the surgery would not resolve Mr J’s pain.

15. On 20 October 2023 Mr J had varicocele surgery. Following discharge Mr J was unable to walk and was not provided any medication. At this point, Mr J was unsure if the surgery had been successful or not as he needed time to heal.

16. On 23 October 2023 Mr J attended the Surgical Assessment Unit (SAU). He reported swelling, bruising, and tenderness which extended to his perineum and involved his whole scrotum and penis.

17. Mr J returned to the SAU on 26 October and remained there overnight. Staff discharged him from the SAU on 27 October.

18. On 1 November 2023 Mr J attended the emergency department (ED). His ED report documented Mr J was unable to stand up for longer than five minutes.

19. On 8 November 2023 Mr J emailed the Trust to complain about an ‘atrocious pain’ in his lower body, an ‘extensive hematoma and swelling far beyond any levels expected and confirmed internal bleeding.’

20. On 27 November 2023 Mr J had a urology clinic appointment to follow-up after surgery. The Trust reported his haematoma had resolved. Mr J told us he continued to experience pain and was unable to work or carry out daily tasks until mid-December.

On 25 January 2024 Mr J had a further follow-up clinic appointment. According to the Trust, Mr J’s symptoms had improved significantly but he was still experiencing sensitivity on close contact with his scrotum area.

25. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

Information provided in the pre-surgery appointment

26. Mr J had two previous unsuccessful attempts at embolisation surgery to treat his pain. He complains during his pre-surgery clinic appointment on 16 October 2023, the Trust did not inform him of the reduced chance of successful surgery due to previous embolisation attempts.

27. Mr J says, because he was not made aware of the chances of successful surgery, he was prevented from making an informed decision on whether to go ahead with the surgery.

28. We found staff acted in line with guidelines on this matter.

29. Our physician adviser explained there is no evidence to suggest that the more embolisation attempts staff try means the chances of success are reduced. However, the risk of chronic pain escalates each time there is an intervention, as with most medical surgeries. They went on to explain, both embolisation and microsurgery (a surgical procedure to tie off or clip the enlarged vein(s)), are recognised and accepted techniques in this instance. As EAU guidelines on varicoceles show, pain resolution after varicocelectomy occurs in 48-90% of patients.

30. Accordingly, EAU guidelines demonstrate embolisation is an appropriate treatment option. Both treatments are supported by evidence and involve different balances of risks and benefits, making patient preference and shared decision-making important considerations when selecting the most appropriate management approach.

31. In terms of reaching decisions on a patient’s care, section ten in the consent guidance explains doctors should give patients the information they want or need. This includes explaining potential risks, uncertainties about, and the likelihood of success regarding the treatment so a patient can reach a decision.

32. Our physician adviser noted the clinic letter dated 16 October 2023 shows evidence of clear counselling from the surgeon regarding possible complications. The surgeon explained to Mr J they were not entirely convinced the pain he described was caused by his small left varicocele. Nevertheless, Mr J was keen to go ahead with the surgery.

33. Further, we have seen evidence Mr J had been repeatedly told his pain was chronic scrotal pain, unlikely to be remedied by surgery. This is noted in the clinic letter the Trust sent to Mr J on 22 December 2022. We view this information as evidence Mr J had been made aware of the potential risks and complications involved with varicocelectomy surgery. This is in line with the consent guidance.

34. We appreciate the distress Mr J endured following his varicocelectomy surgery on 20 October 2022 and understand this was not the outcome he was hoping for as his pain continued.

35. We hope we have clearly explained why we have not found any indication of failings.

Aftercare provided by the Trust

36. Mr J complains the Trust exhibited a lack of aftercare and did not provide adequate instructions nor any medication to manage his pain following surgery. Mr J says the lack of adequate instructions and pain relief on discharge increased his pain and impacted on his mental health, leading to him feeling helpless and unsupported.

37. We found staff acted in line with guidelines on this matter.

38. Our physician adviser explained the degree of pain Mr J experienced was unusual and he should have been able to walk after the surgery.

39. The Trust provided Mr J Naproxen to manage this pain. Naproxen is a nonsteroidal anti-inflammatory drug, used to manage pain, inflammation and fever. Our physician adviser explained Mr J could have waited in hospital for several more days in order for this to resolve but consented to discharge on the same day of surgery.

40. The Trust acknowledge Mr J felt unsupported following the complication after his varicocelectomy surgery in their complaint response sent 7 January 2025.

41. The GMC’s duty of candour guidance requires healthcare providers to be open and honest when things go wrong, explain what has occurred answer questions, and provide appropriate support and follow-up. Our physician adviser explained in this case, the Trust appropriately made contact with Mr J, arranged regular reviews and provided opportunities for ongoing assessment and discussion of his concerns.

42. We appreciate Mr J attended the Surgical Assessment Unit (SAU) and the Emergency Department (ED) as a result of his pain. Despite this, these records indicate the Trust took reasonable steps to provide continuing care and support consistent with standards and guidelines following Mr J’s surgery. This information supports our view no failings occurred in relation to the aftercare provided to Mr J by the Trust.

Haematoma and internal haemorrhage diagnosis

43. Mr J complains following surgery, the Trust delayed recognising his haematoma and internal haemorrhage. He says the delay in diagnosing his haematoma and internal bleeding increased his pain and delayed him going back to work. Mr J says the pain and delayed recovery also impacted on his mental health.

44. We found staff acted in line with guidelines on this matter.

45. A haematoma is a severe blood bruise, typically emerging after injury. It is recorded Mr J experienced bruising and a haematoma after his surgery. An internal haemorrhage is bleeding inside the body. We appreciate the pain and distress Mr J endured as a result of his haematoma and internal haemorrhage. We do not doubt the pain this caused him and the impact this had on his ability to work and earn a living.

46. Section 15 in the GMC good medical practice guidance says, to provide a good standard of care, based on the patient’s condition, doctors should provide or arrange suitable advice or treatment.

47. Our physician adviser explained the expected healing time for varicocelectomy surgery is six weeks. During this period, our physician explained the suitable treatment, which staff should provide, is conservative management (a cautious approach designed at managing symptoms) to see if the situation resolves. In more severe cases the patient’s haematoma may require draining, which our physician explained was not the case for Mr J.

48. As staff took this approach and Mr J’s haematoma resolved by the time of his clinic appointment on 27 November 2023, five weeks after his surgery and within the expected six week healing period, we can see staff acted in line with guidance in recognising and managing his condition.

49. We are sorry to hear of the discomfort and distress the complications following Mr J’s varicocelectomy surgery caused him. Though Mr J’s complications were unusual, he suffered a known complication of varicocelectomy surgery.

50. We can see the Trust followed standards and guidelines throughout his pre-surgery clinic appointment, provided appropriate aftercare according to relevant standards and managed his haematoma and internal haemorrhage following policy and guidelines. As we have not found failings, we will not be looking into Mr J’s complaint any further and we cannot look into awarding his desired outcomes of a formal acknowledgement of failings and a financial remedy.

We have not made this decision without acknowledgement and understanding of the distress and pain Mr J has endured following his surgery. We hope our decision provides Mr J some assurance about what happened with his treatment.

1. We have carefully considered Mr J’s complaint about Surrey and Sussex Healthcare NHS Trust (the Trust). We appreciate Mr J’s varicocelectomy (a surgical procedure to repair enlarged veins in the scrotum, improving fertility and relieving testicular pain) resulted in considerable pain, impacting his work life and his mental health.

2. We have considered the evidence carefully and seen no indication of failings in relation to Mr J’s complaint about the Trust’s care and treatment. This is because, though the degree of pain Mr J experienced seems unusual, the surgery was offered following appropriate standards and guidelines and his pain resembled an expected complication for which he consented. Though we do not doubt the distress and pain Mr J’s haematoma caused, this resolved within six weeks and therefore, the conservative management and aftercare provided by the Trust remained in line with standards and guidance.

3. As we have seen no indication of wrongdoing, we have decided not to investigate further. Our decision is not made without recognition of the pain and distress Mr J endured following his varicocelectomy surgery. We have explained the reasons for our decision below.