Effect of Mesh and its Localisation on Testicular Flow and Spermatogenesis in Patients with Groin Hernia

Abstract

In this study, the long-term effects of mesh and its localisation (i.e. anterior or posterior) on testicular perfusion and testicular function were evaluated in groin hernia patients. Testicular function has been evaluated with spermiogram and testicular perfusion with colour Doppler ultrasonography. Group I: consisted of 30 posterior preperitoneal mesh repair patients Group II: consisted of 30 anterior tension-free repair patients. The operation types were randomised with a systematic sampling method. There was no statistically significant difference between pre-operative and postoperative spermiogram results for both groups. No statistically significant difference was found between the two groups in terms of Doppler flow parameters (PSV, EDV, RI and PI) for pre-operative, early and late postoperative periods. When Doppler flow parameters were compared for group I, statistically significant differences were found between pre-operative and early postoperative values. No statistically significant difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. When Doppler flow parameters were compared for group II, statistically significant differences were found between pre-operative and early postoperative values. No statistically difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. These results support the idea that inguinal mesh application is still a safe procedure in patients with no children or who are undergoing infertility treatment, where testicular function is important.

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

“…This difference had disappeared by the time of the subsequent examination (sixth month), and this was attributed to the trauma of the operation and to tissue edema 16 . These authors did not consider the possibility that these alterations might have occurred because of the inflammatory reaction triggered by the prosthesis.…”

“…This was not what was seen in the present study. Aydede et al 16 observed a decreased *TV = Testicular Volume; SV = Systolic Velocity; DV = Diastolic Velocity; RI = Resistance Index; PI = Pulsatility Index.…”

“…As demonstrated in the studies by Aydede et al 16 and Akbulut et al 17 , the prosthesis produces different repercussions according to where it has been implanted. Placement of the prosthesis in the pre-peritoneal position, as part of a variety of techniques, has been found to cause more repercussions on the testicle and the testicular flow than does the Lichtenstein technique 16,17 . The latter procedure was the only one that presented homogeneous results in dozens of multicenter studies with recurrence rates of 1%.…”

“…These authors concluded that there had been histological changes, with 20% reduction in the animals' spermatogenesis and an inflammatory process involving the vas deferens in 60% of the animals. Aydede et al 16 studied perfusion and testicular function in a randomized clinical trial involving two groups of 30 patients who underwent surgical correction for inguinal hernia, by means of a prosthesis. Group I was operated using the Lichtenstein technique and group II was operated using the totally extraperitoneal technique (TEP).…”

Male infertility after mesh hernia repair: A prospective study

“…In contrast others have found proximal dilatation but no thickening of the wall of the vas deferens 2 . Decreased arterial perfusion in the testis 5,7 and spermatic venous thrombosis 4 have also been reported.. One study has shown beneficial effects on the integrity of the vas deferens when using lightweight mesh 3 whereas another study did not find any difference in inflammation and fibrosis comparing heavyweight with lightweight mesh 8 .…”