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KMID : 1033020150050010001
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Journal of Hemiology: Diagnosis and Treatment of Hernias
2015 Volume.5 No. 1 p.1 ~ p.5
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Risk for Spermatic Cord Injury During Inguinal Herniorrhaphy
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박진우:Park Jin-Woo
저자없음:No authors listed
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Abstract
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The spermatic cord is the cord-like structure in male inguinal canal, which contains the vas deferens, the testicular vessels, the pampiniform plexus, the lymphatic vessels, and nerves. During the hernia repair, iatrogenic injury to the spermatic cord may result in ischemic orchitis, testicular atrophy, hormonal dysfunction, obstruction of the vas deferens compromising fertility. Postoperative orchitis is usually transient and resolves spontaneously without permanent sequelae because of abundant collateral circulation. However it may result in testicular atrophy in less than 1% after routine inguinal hernia repair. In severe atrophic testicle, Leydig cells may lose their function to produce testosterone. The vas deferens may also be injured by iatrogenic transection or compression by the mesh around the cord in 0.3∼7.2% of the patients. The injured vas deferens can lead to oligo- or azoospermia. In addition, most animal studies showed adverse effects of hernia surgery on gonadal function although the results were not consistent. Clinical studies, however, indicate that these potential adverse effects do not seem to have a clinical impact on male fertility in patients with inguinal hernias. Chronic testicular pain (orchialgia) is another disabling complication after inguinal hernia repair. The exact pathophysiology of testicular pain is unknown. The prevalence of dysejaculation and moderate to severe pain-related impairment of sexual activity following inguinal hernia repairs were reported as 3∼4% and 2∼3%, respectively. Further studies with greater number of patients are needed to get more solid conclusions about the clinical impacts of spermatic cord injuries during the inguinal hernia repair.
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KEYWORD
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The spermatic cord, Inguinal hernia, Herniorrhaphy, Mesh, Orchitis, Sexual activity
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