title: Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia?
abstract: OBJECTIVE
  Modern treatment of inguinal hernias includes prosthetic mesh repairs. However, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. The aim of this prospective study was to evaluate the effect of mesh implantation/perimesh fibrosis on testicular flow after repair of indirect inguinal hernias (IIHs).
  
  
  METHODS
  Forty-eight male patients with unilateral IIH were included. Both testicular parenchyma were assessed using gray-scale sonography, and color/spectral Doppler sonography was performed to evaluate testicular arterial impedance, perfusion, and venous flow. Measurements were made bilaterally at the level of the inguinal canal 1 day before and at the end of the 2nd month after the operation.
  
  
  RESULTS
  There was no difference in testicular and echotexture perfusion between the hernia and the control sides pre- and postoperatively. No venous thrombosis was found. In all groups, resistance index and pulsatility index, measured at 4 levels, were highest in the proximal inguinal canal and lowest at the extratesticular-intrascrotal level (p < 0.05). For all Doppler parameters there was no significant difference between the pre- and postoperative measurements on both the hernia and the control sides.
  
  
  CONCLUSIONS
  Mesh implantation/perimesh fibrosis does not adversely affect ipsilateral testicular flow. Mesh application is still a safe procedure in male patients in whom testicular function is important.
authors.affiliation: Department of Radiology, Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey.
authors.forename: Selma Uysal
authors.initials: SU
authors.lastname: Ramadan
authors.forename: Dilek
authors.initials: D
authors.lastname: Gokharman
authors.forename: Isil
authors.initials: I
authors.lastname: Tuncbilek
authors.forename: Hilal
authors.initials: H
authors.lastname: Ozer
authors.forename: Pinar
authors.initials: P
authors.lastname: Kosar
authors.forename: Mahmut
authors.initials: M
authors.lastname: Kacar
authors.forename: Selim
authors.initials: S
authors.lastname: Temel
authors.forename: Ugur
authors.initials: U
authors.lastname: Kosar
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001783:Blood Flow Velocity; D005355:Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D013526:Surgical Mesh / Q000009:adverse effects*; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology