title: Testicular infarction as a sequela of inguinal hernia repair.
abstract: BACKGROUND
  Testicular atrophy and necrosis as a result of ischemic orchitis is a well-established complication after inguinal hernia repair. We reviewed four patients with a recent history of inguinal hernia repair and subsequently developed ischemic orchitis to evaluate management options to provide symptomatic relief and prevent testicular atrophy.
  
  
  METHODS
  The first patient underwent loosening of inguinal hernia mesh for scrotal pain and decreased arterial testicular flow 8 hours after inguinal hernia repair. The second patient developed ischemic orchitis 20 hours after inguinal herniorrphaphy and required removal of mesh. Neither patient had testicular atrophy at their follow up visit. The third patient underwent orchiectomy for testicular pain and intraoperative findings of infarction. The fourth patient never experienced pain but showed testicular atrophy 6 months after inguinal hernia repair and was managed expectantly.
  
  
  CONCLUSIONS
  In our series, testicular ischemia was reversed in two of the four patients with mesh loosening or removal. Prompt evaluation and exploration of suspected ischemic orchitis after inguinal hernia repair may allow symptomatic relief and prevention of testicular atrophy.
authors.affiliation: Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-3232, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Chu
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Averch
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Jackman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects; D013737:Testis / Q000098:blood supply* / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult