Date Published: April 17, 2020
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Sérgio Henrique Bastos Damous, Luciana Lamarão Damous, Jocielle dos Santos Miranda, Edna Frasson de Souza Montero, Cláudio Birolini, Edivaldo Massazo Utiyama.
To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels.
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.
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). 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.
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 type of mesh most commonly employed is polypropylene (PP), and its use causes intense fibroplasia and reinforcement of the abdominal wall in the inguinal region, with consequent reduction in the rates of relapse to less than 1%, in addition to a reduction in the cumulative risk mainly from the first year, compared to the technique without a mesh1-3.
This study was carried out in the Medical Research Laboratory (LIM-62) of the Division of Clinical Surgery III (DCC III) of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP) after approval by the Ethics Committee for Use of Animals in Research of FMUSP under number 089/15. All animals were handled according to the principles of the National Institute of Health (1985) and The American Physiological Society (1995) for the care, handling and use of laboratory animals.
Surgery, with or without the use of the mesh, promoted a reduction in testicular size (p<0.05 No vs. I; Mesh-DD; Mesh-SF); however, serum testosterone levels were similar among all groups (p>0.05) (Table 3, Fig. 4).
Hernia repairs with or without mesh are both proven effective in the treatment of inguinal hernias. On one hand, compared to nonmesh repairs, mesh repairs reduce the rate of hernia recurrence and involve a shorter operation time and faster return to normal activities. On the other hand, testicular complications probably occur slightly more often in mesh repairs and show nearly equivocal results12.
Surgery, with or without mesh placement, did not alter the morphology of the duct deferens, and although this procedure resulted in testicular size reduction, it did not affect serum testosterone levels. Future studies should deepen the analysis of the effect of the PP mesh on the functionality of these organs and the real impact on male fertility.