Sexual function and testicular perfusion after inguinal hernia repair with mesh

Background: Open tension-free techniques of hernia repair using synthetic meshes revealed an excellent patient comfort with low recurrence rates. The influence of the resulting fibrosis on testicular perfusion and sexual function is still unclear. Methods: In a prospective observation study testicular volume, perfusion, and sexual function was investigated before plug and patch repair, after 3 months, and every 6 months thereafter. Testicular volume and perfusion was examined by a standardized scrotal ultrasound and duplex sonography. Sexual function was assessed by a validated anonymized questionnaire. Results: Seventy-three patients were included and follow-up examinations by questionnaire and sonography, respectively, were completed in 73 and 68 patients after 3 months, 51 and 43 after 6, and 24 and 14 after 12 months. Preoperative testicular volume and flow volume was comparable between the side of hernia and the contralateral side (average 10.2 ± 4.8 cm3 versus 9.8 ± 5.3, respectively) and showed no significant differences during follow-up. In 11 (15%) patients with preexisting disorders sexual function was normalized postoperatively. Ten (14%) other patients (3 of them with neuralgia pain) described limitations of sexual activity due to inguinal pain (n = 4; 6%) or a loss of sensivity in the inguinal area (n = 6; 8%) after the procedure. Among these, sexual function recovered spontaneously within 12 months postoperatively in 6 patients (2 with inguinal pain, 4 with loss of sensitivity). In all other patients sexual function showed no changes after inguinal hernia repair. Conclusions: So far there is no evidence for a significant impairment of the cord structures and the sexual function after inguinal hernia repair in the plug and patch technique.