Bilateral Endoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair Does Not Induce Obstructive Azoospermia: Data of a Retrospective and Prospective Trial

Skawran, S.; Weyhe, Dirk; Schmitz, Britta; Belyaev, Orlin; Bauer, Karl-Heinz

doi:10.1007/s00268-011-1072-0

Cited by 19 publications

(14 citation statements)

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“…The observed decrease in testicular volume following a totally extraperitoneal hernia repair was not significant or consistent with a diagnosis of testicular atrophy. Other studies did not show a statistically significant difference in preoperative and postoperative testicular volume following inguinal hernia repair [15,17,20]. The studies that evaluated the impact of herniorrhaphy on testicular perfusion and volume examined adult patients with inguinal hernias, not pediatric patients.…”

Section: + Modelmentioning

confidence: 99%

Effects of single-port laparoscopic percutaneous extraperitoneal closure on the orientation of the vas deferens and testicular perfusion and volume: Experience from a single center

et al. 2016

Journal of Pediatric Urology

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Section: + Modelmentioning

confidence: 99%

Effects of single-port laparoscopic percutaneous extraperitoneal closure on the orientation of the vas deferens and testicular perfusion and volume: Experience from a single center

et al. 2016

Journal of Pediatric Urology

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“…Relevant clinical – and especially large and prospective - studies on the subject, are limited; up until now, only two studies addressed the problem of fertility after endoscopic TEP hernia repair [13,14]. …”

Section: Introductionmentioning

confidence: 99%

Male infertility after endoscopic Totally Extraperitoneal (Tep) hernia repair (Main): rationale and design of a prospective observational cohort study

et al. 2012

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BackgroundTo describe the rationale and design of an observational cohort study analyzing the effects of endoscopic Totally Extraperitoneal (TEP) hernia repair on male fertility (MAIN study).Methods and designThe MAIN study is an observational cohort study designed to assess fertility after endoscopic TEP hernia repair. The setting is a high-volume single center hospital, specialized in TEP hernia repair. Male patients of 18-60 years of age, with primary, reducible, bilateral inguinal hernias and no contraindications for endoscopic TEP repair are eligible for inclusion in this study. Patients with an ASA-classification ≥ III and patients with recurrent and/or scrotal hernias and/or a medical history of pelvic surgery and/or radiotherapy, known fertility problems, diabetes and/or other diseases associated with a risk of fertility problems, will be excluded. The primary outcome is the testicular perfusion before and 6 months after TEP hernia repair (assessed by means of a scrotal ultrasonography). Secondary endpoints are the testicular volume (Ultrasound), semen quality and quantity and the endocrinological status, based on serum levels of the sexual hormones follicle-stimulating hormone (FSH), luteinizing hormone (LSH), testosterone and inhibin B before and 6 months after TEP hernia repair.DiscussionThe use of polypropylene mesh is associated with a strong foreign body reaction which could play a role in chronic groin pain development. Since the mesh in (endoscopic) inguinal hernia repair is placed in close contact to the vas deferens and spermatic vessels, the mesh-induced inflammatory reaction could lead to a dysfunction of these structures. Relevant large and prospective clinical studies on the problem are limited. This study will provide a complete assessment of fertility in male patients who undergo simultaneous bilateral endoscopic TEP hernia repair, by analyzing testicular perfusion and volume, semen quantity and quality and endocrinological status before and 6 months after TEP repair.Trial registrationThe MAIN study is registered in the Dutch Trial Register (NTR2208)

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“…Nevertheless, case reports evoked the potential risk of infertility due to an obstructive azoospermia, and animal studies seemed to provide some evidence of such a complication [1]. But how common is such problem in clinical practice and how significant is it?…”

Section: Introductionmentioning

confidence: 99%

“…In small animals in particular, cord structures are much thinner and therefore more vulnerable to any manipulation [3,4]. Fourth, the study by Skawran et al [1] provides good evidence that the problem of male infertility due to obstruction of the spermatic cord has no clinical importance. Moreover, 90% of all inguinal hernia repairs are unilateral operations and fertility is preserved by the nonoperated side.…”

Section: Introductionmentioning

confidence: 99%