Kristin A Sonderman1,2, Lindsey L Wolf3,4, Lindsey B Armstrong5, Kathryn Taylor6, Wei Jiang3, Brent R Weil5, Tracey P Koehlmoos7, Robert L Ricca7, Christopher B Weldon5, Adil H Haider3,4, Samuel E Rice-Townsend5. 1. Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA. kojomo@bwh.harvard.edu. 2. Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. kojomo@bwh.harvard.edu. 3. Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA. 4. Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Surgery, Boston Children's Hospital, Boston, MA, USA. 6. Harvard Medical School, Boston, MA, USA. 7. Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Abstract
PURPOSE: We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children. METHODS: We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including > 3 million children. We abstracted data on male children < 12 years who underwent inguinal hernia repair (2005-2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis. RESULTS: 8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1-5). Median follow-up was 3.57 years (IQR 1.69-6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children [Formula: see text] 5 years, with 72% in children < 2 years. Median time to atrophy was 2.4 years (IQR 0.64-3), with 30% occurring within 1 year and 75% within 3 years. CONCLUSION: Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later. LEVEL OF EVIDENCE: Prognosis Study, Level II.
PURPOSE: We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children. METHODS: We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including > 3 million children. We abstracted data on male children < 12 years who underwent inguinal hernia repair (2005-2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis. RESULTS: 8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1-5). Median follow-up was 3.57 years (IQR 1.69-6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children [Formula: see text] 5 years, with 72% in children < 2 years. Median time to atrophy was 2.4 years (IQR 0.64-3), with 30% occurring within 1 year and 75% within 3 years. CONCLUSION:Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later. LEVEL OF EVIDENCE: Prognosis Study, Level II.
Authors: Kate A Stewart; Patricia C Higgins; Catherine G McLaughlin; Thomas V Williams; Elder Granger; Thomas W Croghan Journal: Arch Pediatr Adolesc Med Date: 2010-06-07