Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia.
OBJECTIVE
To report a multiinstitutional experience of men presenting with infertility secondary to inguinal hernia repair using polypropylene mesh.


BACKGROUND
An estimated 80% of inguinal hernia operations involve placement of a knitted polypropylene mesh to form a "tension-free" herniorrhaphy. The prosthetic mesh induces a chronic foreign-body fibroblastic response creating scar tissue that imparts strength to the floor and leads to fewer recurrences. However, little is known about the long-term effects of the polypropylene mesh on the vas deferens, especially with regard to fertility.


METHODS
Eight institutions in the United States reported a total of 14 cases of azoospermia secondary to inguinal vasal obstruction related to previous polypropylene mesh herniorrhaphy. Patient characteristics and operative findings were forwarded to 1 center for tabulation of data.


RESULTS
Mean patient age was 35.5 years with an average duration of infertility of 1.8 years. Mean number of years between urologic evaluation and herniorrhaphy was 6.3 years. Types of inguinal hernia repair previously performed were: open (10), laparoscopic (2), or both (2). Nine patients had bilateral obstruction and 5 patients had unilateral obstruction with contralateral testicular atrophy or epididymal obstruction. Surgical exploration revealed a dense fibroblastic response encompassing the polypropylene mesh with either trapped or obliterated vas in all patients. Surgical reconstruction was performed in 8 of 14 men (57%).


CONCLUSIONS
Reconstruction to restore fertility can be difficult secondary to fibrotic reaction. Before undergoing polypropylene mesh herniorrhaphy, men, especially of young reproductive age or with a solitary testicle, need to be carefully advised of potential obstruction and compromise to future fertility.
Shin
David
D
Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
Lipshultz
Larry I
LI
Goldstein
Marc
M
Barmé
Gregory A
GA
Fuchs
Eugene F
EF
Nagler
Harris M
HM
McCallum
Stewart W
SW
Niederberger
Craig S
CS
Schoor
Richard A
RA
Brugh
Victor M
VM
Honig
Stanton C
SC
D000328:Adult; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000150:complications* / Q000175:diagnosis; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007248:Infertility, Male / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D009845:Oligospermia / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011126:Polypropylenes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome; D014649:Vas Deferens / Q000503:physiopathology / Q000601:surgery
D011126:Polypropylenes