Testicular atrophy is a rare but recognized complication following inguinal hernia repair. The testicle’s dual role in hormone production and fertility makes the shrinkage of the organ a serious issue. This article provides context for understanding the complication, including its mechanisms, incidence, and management.
What Is Testicular Atrophy
Testicular atrophy is defined by the loss of tissue volume within one or both testicles, resulting in a noticeable reduction in size. This shrinkage is distinct from the normal temporary contraction of the scrotum. The testicles contain specialized cells that produce sperm (germ cells) and testosterone (Leydig cells). When atrophy occurs, the tissue responsible for these functions is diminished, leading to functional consequences.
The most perceptible symptom is visible shrinkage, and the testicle may feel softer than usual. A drop in hormone levels can accompany the tissue loss, potentially manifesting as a reduced sex drive or decreased muscle mass. Atrophy can also impair sperm production, which may result in infertility, especially if both testicles are affected.
Why Hernia Surgery Can Lead to Atrophy
Testicular atrophy following inguinal hernia repair is linked to the delicate anatomy of the groin region. The testicle receives its blood supply through the spermatic cord, which travels through the inguinal canal—the location of the repair. The primary mechanism causing atrophy is the disruption of this blood supply, leading to ischemia (lack of oxygenated blood flow).
The spermatic cord houses the testicular artery and the pampiniform plexus (draining veins). During surgical dissection to separate the hernia sac, these vessels can be injured, compressed, or develop blood clots (thrombosis). This interruption restricts blood flow, leading to tissue damage and subsequent death, which manifests as atrophy over time. Extensive manipulation near the spermatic cord increases the potential for vascular compromise.
How Common Is This Complication
Testicular atrophy is considered an uncommon complication following inguinal hernia repair. For a routine, first-time repair, the incidence rate is low, often reported between 0.3% and 1.2%. The risk is higher in complex cases or those involving pre-existing conditions.
The incidence rate can rise significantly, sometimes up to 5%, in patients undergoing repeat procedures or emergency repairs for incarcerated hernias. Increased likelihood factors include advanced age and underlying conditions such as diabetes or rheumatological diseases. The surgical approach also plays a role, with some studies suggesting a higher rate in open repairs compared to laparoscopic techniques.
Diagnosing and Addressing the Condition
Diagnosis of testicular atrophy begins with a physical examination to assess the size and consistency of the testicle. If atrophy is suspected, the condition is confirmed using imaging, typically a Doppler ultrasound. This specialized ultrasound measures the testicle’s volume and visualizes blood flow through the testicular artery and veins.
A prompt evaluation is necessary if the patient experiences symptoms of ischemic orchitis (scrotal pain and swelling) within days of the procedure, as this can progress to atrophy. Management of acute ischemia may involve surgical intervention to relieve compression, such as removing a hematoma or releasing a tight ligature. Once atrophy is established, long-term management focuses on monitoring hormonal health via blood tests. If testosterone production is impaired, hormone replacement therapy may be recommended, and a testicular prosthesis can be considered for cosmetic concerns.