Herniorrhaphy With Polypropylene Mesh Causing Inguinal Vasal Obstruction: A Preventable Cause of Obstructive Azoospermia

Shin, David; Lipshultz, Larry I.; Goldstein, Marc; Barme, G; Fuchs, Eugene F.; Nagler, Harris M.; McCallum, Stewart W.; Niederberger, Craig S.; Schoor, Richard A.; Brugh, Victor M.; Honig, Stanton C.

doi:10.1016/s0022-5347(05)00116-3

Cited by 52 publications

(86 citation statements)

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“…The techniques, tactics, prostheses and everything that could be related to the surgical correction of hernias need to be considered. Shin et al 19 reported on 14 cases of azoospermia among patients who underwent operations using the Lichtenstein technique and concluded that their infertility was related to the use of polypropylene prostheses that had favored obstruction of the vas deferens. Reports like this one from Shin et al 19 are rare in the literature and generally are series with few cases.…”

Section: Analysis Of the Testicular Flowmentioning

confidence: 99%

“…Shin et al 19 reported on 14 cases of azoospermia among patients who underwent operations using the Lichtenstein technique and concluded that their infertility was related to the use of polypropylene prostheses that had favored obstruction of the vas deferens. Reports like this one from Shin et al 19 are rare in the literature and generally are series with few cases. Damage to the vas deferens and testicle are complications from surgical correction for inguinal hernias 6,20 .…”

Section: Analysis Of the Testicular Flowmentioning

confidence: 99%

“…On the side without the mesh, 71% of the animals presented chronic inflammatory reaction. Shin et al 19 studied 14 patients with azoospermia secondary to obstruction of the vas deferens following surgical correction of hernias using prostheses. An exploratory operation revealed dense fibroblastic reaction involving the mesh and obstructing the vas deferens.…”

Section: Introductionmentioning

confidence: 99%

“…An exploratory operation revealed dense fibroblastic reaction involving the mesh and obstructing the vas deferens. They concluded that there was a relationship between the prostheses and the cases of infertility due to obstruction of the vas deferens 19 . Fitzgibbons 20 commented that infertility could be caused by an iatrogenic effect on the vas deferens or by testicular damage.…”

Section: Introductionmentioning

confidence: 99%

“…The use of prostheses for surgical corrections for inguinal hernias reaches beyond a worldwide consensus: it is also an ethical management method, since it provides high satisfaction rates with low recurrence rates 8 . Nonetheless, it is necessary to continuously study the effects of prostheses on flow and testicular volume 19 .…”

Section: Introductionmentioning

confidence: 99%

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

2007

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Purpose:To evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. Methods: This was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types III A and III B according to the Nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the Lichtenstein technique. The patients were evaluated using Doppler ultrasound before the operation and selectively at the third and sixth months after the operation. The variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. Results: No statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). Conclusion: No alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prothesis. Key words: Testis. Surgical Mesh. Hernia, Inguinal. RESUMO Objetivo:Avaliar o volume testicular e o fluxo na artéria testicular em pacientes operados de inguinal com prótese de polipropileno. Métodos: Estudo clínico prospectivo observacional em 39 pacientes do sexo masculino portadores de hérnia inguinal tipo III A e III B na classificação de Nyhus os quais foram submetidos a hernioplastia inguinal com implantação de prótese de polipropileno com a técnica de Lichtenstein. Os pacientes foram avaliados com ultra-sonografia Doppler no pré-operatório; no 3º mês e no 6º mês de pós-operatório. As variáveis estudadas foram: volume testicular; velocidade sistólica e diastólica, o índice de resistividade e o índice de pulsatilidade. Resultados: Não se observou alterações estatisticamente significantes nas variáveis ao longo do tempo: volume testicular (p=0,197); velocidade sistólica (p=0,257); velocidade diastólica (p=0,554); índice de resistividade (p=0,998); índice de pulsatilidade (p=0,582). Conclusão: Não se observou alteração no volume testicular e no fluxo sanguíneo da artéria testicular após seis meses nos pacientes submetidos à correção cirúrgica de hérnia inguinal com prótese de polipropileno.. Descritores: Testículo. Telas Cirúrgicas. Hérnia Inguinal. -ORIGINAL ARTICLE

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Section: Analysis Of the Testicular Flowmentioning

confidence: 99%

Section: Analysis Of the Testicular Flowmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2007

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Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia

Bringman

Wollert

Österberg

et al. 2006

British Journal of Surgery

190

127

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Beneficial effects of hydrocortisone or spironolactone coating on foreign body response to mesh biomaterial in a mouse model

Brandt

Kämmer

Fiebeler

et al. 2011

J Biomedical Materials Res

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Prosthetic reinforcements markedly reduce the risk of hernia recurrence. However, the implantation of meshes is related to an inflammatory foreign body reaction (FBR) with serious complications (i.e., persistent seroma, wound infection, mesh migration, entrapment, chronic pain). Adrenal hormones profoundly modify inflammatory response. Their effects on FBR however, remain ill defined. We therefore studied the FBR to polyvinylidenfluoride (PVDF) mesh material that was coated with four different substances: hydrocortisone (COR) or mifepristone (MIF), which respectively stimulate and block the glucocorticoid receptor, and aldosterone (ALD) or spironolactone (SPI), which respectively stimulate and block the mineralocorticoid receptor. The coated substances were released from the meshes within 24 h. Seven, 21, and 90 days after implantation, the specimen was evaluated for collagen formation, granuloma size, inflammatory activity, and angiogenesis. COR and SPI coating protected from inflammatory response, while ALD and MIF coating showed little difference to the control group. The COR and SPI groups showed smaller granuloma sizes at all time points, as well as a reduced number of inflammatory cells (p < 0.001) at day 90, and decreased collagen formation starting after 21 days (p < 0.05). There was a negative correlation for angiogenesis with inflammation around foreign body structures. In summary, these results suggest that early and temporary stimulation of the glucocorticoid receptor or blockade of the mineralocorticoid receptor have beneficial effects on FBR in the long term.

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Herniorrhaphy With Polypropylene Mesh Causing Inguinal Vasal Obstruction: A Preventable Cause of Obstructive Azoospermia

Cited by 52 publications

References 0 publications

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

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

Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia

Beneficial effects of hydrocortisone or spironolactone coating on foreign body response to mesh biomaterial in a mouse model

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