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Beneficial effect of inguinal hernioplasty on testicular perfusion and sexual function

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Abstract

Aim

To evaluate the effects of Lichtenstein tension-free inguinal hernioplasty on sexual function and generic quality of life, testicular volume, and perfusion.

Patients and methods

In a prospective study, testicular volume, testicular perfusion, sexual function, generic quality of life, chronic inguinal pain, and groin sepsis were investigated before and 3 and 9 months after surgical hernia repair.

Results

Forty male patients completed this study. No differences in testicular volume or in peak systolic velocity were observed between the hernia and healthy sides of the body (P > 0.05). Preoperatively, there was a significantly higher end diastolic velocity (P < 0.04) and resistive index (P < 0.001) on the hernia side compared with the normal side; these elevations returned to normal postoperatively. Three months postoperative, the studied sexual function domains, except orgasm domain, and total sexual score presented significant improvement (P s < 0.05 and 0.001 respectively). By the end of the study, the mean total sexual score and the number of patients with enhanced total score had showed further clinical progress. The total generic quality-of-life score, general health perception and physical function, vitality, and social domains were statistically recovered at 3 months postoperative (P < 0.05), with further improvement in total score at 9 months. Two patients developed superficial groin sepsis, and seven (17.5%) experienced chronic inguinal pain.

Conclusion

Inguinal hernia impaired testicular perfusion that improved postoperatively. Lichtenstein tension-free hernioplasty improved sexual function and generic quality of life without adverse mesh effects on testicular volume or perfusion.

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References

  1. Fitzgibbons RJ Jr, Richards AT, Quinn TH (2007) Open hernia repair. In: Wiley SW, Mitchell FP, Gregory JJ, Larr KR, William PH, John P, Nathaniel SJ (eds) ACS surgery: principles and practice, vol 5, 6th ed. Web MD, Atlanta, pp 154–167

  2. Coob WS, Kercher KW, Heniford T (2005) The argument for lightweight polypropylene mesh in hernia repair. Surg Innov 12(1):20–27

    Google Scholar 

  3. Lichtenstein IL, Shulman AG, Amid PK, Montflor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193

    Article  PubMed  CAS  Google Scholar 

  4. Turgut AT, Olcucuoglu E, Turan C, Kilicoglu B, Kosar P, Geyik PO, Kosar U, Dogra V (2007) Preoperative ultrasonographic evaluation of testicular volume and blood flow in patients with inguinal hernias. J Ultrasound Med 26(12):1657–1666

    PubMed  Google Scholar 

  5. Hubner M, Vuilleumier H, Demartines N (2008) Sexual impairment due to mesh plug hernia repair? ANZ J Surg 78:213–219

    Article  PubMed  Google Scholar 

  6. Amid PK, Friis E, Horeyseck G, Kux M (1999) A multi-center experience with 6764 Lichtenstein tension-free hernioplasties. Hernia 3:47–8

    Google Scholar 

  7. Shin D, Lipshultz LI, Goldstein M, Barme GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM, Honig SC (2005) Herniorrhaphy and polypropylene mesh causing inguinal vassal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 241(4):553–558

    Article  PubMed  Google Scholar 

  8. Nordin P, Bartelmess P, Jansson C, Svensson C, Edlund G (2002) Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice. Br J Surg 89:45–49

    Article  PubMed  CAS  Google Scholar 

  9. Koc M, Aslar AK, Yoldas O, Ertan T, Kilic M, Gocmen E (2004) Comparison of quality-of-life outcomes of Stoppa vs. bilateral Lichtenstein procedure. Hernia 8:53–55

    Article  PubMed  CAS  Google Scholar 

  10. Pokorny H, Klingler A, Scheyer M, Fugger R, Bischof G (2006) Postoperative pain and quality of life after laparoscopic and open inguinal hernia repair: results of a prospective randomized trial. Hernia 10(4):331–337

    Article  PubMed  CAS  Google Scholar 

  11. Zieren J, Menenakos C, Paul M, Muller JM (2005) Sexual function before and after mesh repair of inguinal hernia. Int J Urol 12:35–38

    Article  PubMed  Google Scholar 

  12. Beltran MA, Burgos C, Almonacid J, Larenas R, Tapia TF, Vicencio A, Danilova T, Martinez H, Cruces KS, Araya G (2005) Long-term follow-up of tension-free Lichtenstein hernioplasty: application of a qualitative and quantitative measurement instrument. Hernia 9(4):368–374

    Article  PubMed  CAS  Google Scholar 

  13. Silen W (2002) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 89:123

    PubMed  CAS  Google Scholar 

  14. Amid PK (2002) The Lichtenstein repair in 2002: an overview of causes of recurrence after Lichtenstein tension-free hernioplasty. Hernia 7:13–16

    PubMed  Google Scholar 

  15. Mihmanli I, Kantarci F, Kulaksizoglu H et al (2004) Testicular size and vascular resistance before and after hydrocelectomy. Am J Roentgenol 183:1379–1385

    Google Scholar 

  16. Ertan T, Keskek M, Kilic M, Dizen H, Koc M, Tez M (2007) Recovery of sexual function after scrotal hernia repair. Am J Surg 194:299–303

    Article  PubMed  Google Scholar 

  17. McGillicuddy JE (1998) Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures. Arch Surg 133:974–978

    Article  PubMed  CAS  Google Scholar 

  18. International Association for Study of Pain, Subcommittee on Taxonomy (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl 3:S1–S556

    Google Scholar 

  19. Davis CJ, Arregui ME (2003) Laparoscopic repair for groin hernias. Surg Clin N Am 83:1141–1161

    Article  PubMed  Google Scholar 

  20. Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorraphy. Br J Anaesth 95(1):69–76

    Article  PubMed  CAS  Google Scholar 

  21. Devor M, Rober P (1990) Heritability of symptoms in an experimental model of neuropathic pain. Pain 42:51–57

    Article  PubMed  CAS  Google Scholar 

  22. Aufenacker JJ, Geldere D (2005) The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia. A multicentric double blinded randomized control trial. Ann Surg 240(6):955–961

    Article  Google Scholar 

  23. Haq Najam-ul, Chaudry IA, Khan BA, Afzal M (2006) Groin sepsis following Lichtenstein inguinal hernioplasty without antibiotics prophylaxis: a review of 100 cases. Pak J Med Sci 22.4:416–419

    Google Scholar 

  24. Maciel LC, Glina S, Palma PCR, Costa NFC, Netto NR (2007) Histopathological alterations of the vas deferens in rats exposed to polypropylene mesh. BJU Int 100(1):187–190

    Article  PubMed  Google Scholar 

  25. Beddy P, Ridgway PF, Geoghegan T, Peirce C, Govender P, Kean FB, Torreggiani WC, Conlon KE (2006) Inguinal hernia repair protects testicular function: a prospective study of open and laparoscopic herniorraphy. Am Coll Surg 203(1):17–23

    Article  Google Scholar 

  26. Lima Neto EV, Goldenberg A, Juca MJ (2007) Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia. Acta Cir Bras 22(4):226–271

    Article  Google Scholar 

  27. Wantz GE (1982) Testicular atrophy as a risk of inguinal hernioplasty. Surg Gynecol Obstet 154:570–571

    PubMed  CAS  Google Scholar 

  28. Fitzgibbons RJ (2005) Can we be sure polypropylene mesh causes infertility? Ann Surg 241(4):559–561

    Article  PubMed  Google Scholar 

  29. Zwiebel WJ, Pellerito JS (2005) Conceitos basicos da analise do espectro de frequencia Doppler e exame ultra-sonico do fluxo sanguineo. In: Zwiebel WJ, Pellerito JS (eds) Introducao a ultra-sonografia vascular. Elsevier, Sao Paulo, pp 45–64

  30. Kahraman S, Genctoy G, Gil B et al (2004) Prediction of renal allograft function with early Doppler ultrasonography. Transplant Proc 36(5):1348–1351

    Article  PubMed  CAS  Google Scholar 

  31. Taylor SG, Hair A, Baxter GM, O’Dwyer PJ (2001) Does contraction of mesh following tension free hernioplasty effect testicular or femoral vessel blood flow? Hernia 5:13–15

    Article  PubMed  CAS  Google Scholar 

  32. Pepe P, Aragona F (2007) Testicular ischemia following mesh hernia repair and acute prostatitis. Ind J Urol 23(3):323–325

    Article  Google Scholar 

  33. Zieren J, Beyersdorff D, Beier KM, Muller JM (2001) Sexual function and testicular perfusion after inguinal hernia repair with mesh. Am J Surg 181:204–206

    Article  PubMed  CAS  Google Scholar 

  34. Aydede H, Erhan Y, Sakarya A, Kara E, Ilkgul O, Can M (2003) Effect of mesh and its localization on testicular flow and spermatogenesis in patients with groin hernia. Acta Chir Belg 103:607–610

    PubMed  CAS  Google Scholar 

  35. Ramadan SU, Gokharman P, Tuncbilek I, Ozer H, Kosar P, Kosar U (2007) Does mesh/perimesh fibrosis have an effect on testicular flow in patients with repaired inguinal hernia? Utraschall Med 28 (abstract)

  36. Kulah B, Kulacoglu H, Oruc T, Duzgun AP, Moran M (2001) Presentation and outcome of incarcerated external hernias in adults. Am J Surg 181:101–104

    Article  PubMed  CAS  Google Scholar 

  37. Kurzer M, Belsham PA, Kark AE (2002) Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg 89:90–93

    Article  PubMed  CAS  Google Scholar 

  38. Mathur S, Bartlett AS, Gilkison W, Krishina G (2006) Quality of life assessment in patients with inguinal hernia. ANZ J Surg 76:491–493

    Article  PubMed  Google Scholar 

  39. Stengel P, Lange V (1998) Quality of life after inguinal hernia repair—results of prospective study. Langebecks Arch Chir Suppl Kongressbd 115:1020–1023

    CAS  Google Scholar 

  40. Jones KR, Burney RE, Peterson M, Christy B (2001) Return to work after inguinal hernia repair. Surgery 129:128–135

    Article  PubMed  CAS  Google Scholar 

  41. Kingsnorth AN, Porter CS, Bennett DH, Walker AJ, Hyland ME, Sodergren S (2000) Lichtenstein patch or Perfix plug-and-patch in inguinal hernia: a prospective double-blind randomized controlled trial of short-term outcome. Surgery 127:276–283

    Article  PubMed  CAS  Google Scholar 

  42. Vlastos JM, Fragiadaki E, Vlastos S, Gkouskou K (2007) Quality of life in patients who refuse surgical repair of inguinal hernia. Internet J Surg 11(2)

  43. Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126

    Article  PubMed  CAS  Google Scholar 

  44. Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe pain following repair of groin hernia. Br J Surg 89:1310–1314

    Article  PubMed  CAS  Google Scholar 

  45. Fitzgibbons RJ Jr, Gibbie-Hurder A, Gibbs JO (2006) Watchful waiting vs. repair of inguinal hernia in minimally symptomatic men: a randomized controlled trial. JAMA 295(3):285–292

    Article  PubMed  CAS  Google Scholar 

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Correspondence to S. E. El-Awady.

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El-Awady, S.E., Elkholy, A.AM. Beneficial effect of inguinal hernioplasty on testicular perfusion and sexual function. Hernia 13, 251–258 (2009). https://doi.org/10.1007/s10029-009-0480-7

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  • DOI: https://doi.org/10.1007/s10029-009-0480-7

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