Abstract
Purpose To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels.Methods Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh — cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured.Results The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05).Conclusion Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.
Highlights
The implantation of a synthetic mesh for the correction of inguinal hernias created a new paradigm in the treatment of this condition, and its use today is a consensus in the world literature
The animals were distributed into four study groups with 10 animals each, as follows: 1) nonoperated animals (No) surgery (No): intact animals; 2) Inguinotomy (I): animals submitted to a bilateral 3 cm incision, spermatic funicular exposure and dissection of the vas deferens without mesh implant and posterior wall closure; 3) Mesh placed on the duct deferens (Mesh-DD), so that the layout of the mesh simulates the laparoscopic technique; and 4) Mesh placed on the spermatic funiculus (Mesh-SF), in which the mesh layout simulated the Lichtenstein technique (Fig. 1)
In groups No and I, all segments of the duct deferens were preserved in morphology
Summary
The implantation of a synthetic mesh for the correction of inguinal hernias created a new paradigm in the treatment of this condition, and its use today is a consensus in the world literature. The use of meshes can cause complications due to the intense inflammatory response that is induced, such as inflammation around the screen, chronic pain in up to 15-30% of patients[5], and impairment of male fertility[6,7,8]. It was observed that the use of PP meshes causes morphological changes and even obstruction of the vas deferens[9]. There are several case reports and clinical studies with divergent results regarding fertility preservation[6,7,8,11], while doubts remain about the real impact of mesh use on male fertility, mainly in bilateral corrections
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