M Khodari1, A Ouzzane2, F Marcelli3, R Yakoubi2, V Mitchell4, P Zerbib5, J-M Rigot6. 1. Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France. Electronic address: muhieddine.khodari@gmail.com. 2. Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France. 3. Service d'urologie, université de Lille, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000 Lille, France; Service d'andrologie, université de Lille, CHRU de Lille, 59000 Lille, France. 4. Laboratoire de biologie de la reproduction, université de Lille, CHRU de Lille, Lille, France. 5. Service de chirurgie digestive et transplantation, université de Lille, CHRU de Lille, 59000 Lille, France. 6. Service d'andrologie, université de Lille, CHRU de Lille, 59000 Lille, France.
Abstract
BACKGROUND: Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. METHOD: Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. RESULTS: Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). CONCLUSION: The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. LEVEL OF EVIDENCE: 5.
BACKGROUND:Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. METHOD: Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. RESULTS: Among 69 azoospermiapatients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). CONCLUSION: The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. LEVEL OF EVIDENCE: 5.