Various options of hernioplasty and their influence on reproductive health in men
The OBJECTIVE was to study the impact of various hernioplasty methods on the reproductive system.METHODS AND MATERIALS. The study was performed in two groups of patients. Depending on the herniatomy technique, the patients were divided into two groups. Desarda hernia repair was performed in the first group, and Shouldice hernioplasty - in the second group. The study included 68 patients with inguinal hernia. 38 patients from the first group underwent operative interventions, and 30 patients from the second group underwent Shouldice hernioplasty. Both analyzed groups were identical. Prior to operative treatment and in 20 days, 6 months and a year after operation, color duplex scanning of arteries and veins of the spermatic cord was performed on an ALOKA SSD ultrasonic scanner - 1700 with a linear sensor of 7.5 MHz. A sperm morphology was studied 6 days before the operation, 3 months later and one year after the operation according to the Kruger - Menkveld criteria.RESULTS. Laboratory tests of ejaculate are an integral part of examination of patients, necessary for diagnostics of genital glands functional disorders and the statement on the fertility of the patients. The test showed that the concentration, sperm motility and testosterone level were better with Desarda surgery than with Shouldice. Ultrasonic sonoelastography was performed in 58 patients (85.3 % of patients in both groups). Decreased tissue elasticity and increased testicular tissue density were observed in 25 (36.8 %) patients before surgery. Positive changes in the testicular blood flow velocity were noted in the patients with indirect inguinal hernias surgically operated by the Desarda technique. In patients surgically operated by the Shouldice technique, the resistance index significantly increased, which is typical for spermatic cord compression (p<0.005). 6 months after operation, the blood flow normalized in 97.4 % of patients surgically operated by Desarda technique, and in 66.6 % of patients surgically operated by Shouldice method. CONCLUSION. Based on the data analysis, Desarda hernioplasty has a minimal impact on the epidemiologic testicular function and preferably for patients of reproductive age in order to maintain reproductive function.