title: Sexual function and testicular perfusion after inguinal hernia repair with mesh.
abstract: BACKGROUND
  Open tension-free techniques of hernia repair using synthetic meshes revealed an excellent patient comfort with low recurrence rates. The influence of the resulting fibrosis on testicular perfusion and sexual function is still unclear.
  
  
  METHODS
  In a prospective observation study testicular volume, perfusion, and sexual function was investigated before plug and patch repair, after 3 months, and every 6 months thereafter. Testicular volume and perfusion was examined by a standardized scrotal ultrasound and duplex sonography. Sexual function was assessed by a validated anonymized questionnaire.
  
  
  RESULTS
  Seventy-three patients were included and follow-up examinations by questionnaire and sonography, respectively, were completed in 73 and 68 patients after 3 months, 51 and 43 after 6, and 24 and 14 after 12 months. Preoperative testicular volume and flow volume was comparable between the side of hernia and the contralateral side (average 10.2 +/- 4.8 cm3 versus 9.8 +/- 5.3, respectively) and showed no significant differences during follow-up. In 11 (15%) patients with preexisting disorders sexual function was normalized postoperatively. Ten (14%) other patients (3 of them with neuralgia pain) described limitations of sexual activity due to inguinal pain (n = 4; 6%) or a loss of sensitivity in the inguinal area (n = 6; 8%) after the procedure. Among these, sexual function recovered spontaneously within 12 months postoperatively in 6 patients (2 with inguinal pain, 4 with loss of sensitivity). In all other patients sexual function showed no changes after inguinal hernia repair.
  
  
  CONCLUSIONS
  So far there is no evidence for a significant impairment of the cord structures and the sexual function after inguinal hernia repair in the plug and patch technique.
authors.affiliation: Department of General, Visceral, Vascular, and Thoracic Surgery, Charité, Campus Mitte, Humboldt University of Berlin, Schumannstrasse 20/21, D-10117, Berlin, Germany. jurgen.zieren@charite.de
authors.forename: J
authors.initials: J
authors.lastname: Zieren
authors.forename: D
authors.initials: D
authors.lastname: Beyersdorff
authors.forename: K M
authors.initials: KM
authors.lastname: Beier
authors.forename: J M
authors.initials: JM
authors.lastname: Müller
mesh_terms: D006552:Hernia, Inguinal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012611:Scrotum / Q000000981:diagnostic imaging; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000209:etiology*; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color