Department of General Surgery, Kuopio University Hospital, 70211, Kuopio, Finland.
Hernia. 2015 Feb;19(1):53-9. doi: 10.1007/s10029-013-1150-3. Epub 2013 Aug 9.
Testicular ischemia and necrosis are uncommon complications after inguinal hernioplasty. Our aim was to evaluate the incidence of severe urological complications related to adult inguinal hernia surgery in Finland with special reference to orchiectomy in relieving intractable chronic testicular pain.
All urological complications related to inguinal hernia surgery during 2003-2010 were analysed from the Finnish Patient Insurance Centre. The patients with intractable chronic scrotal or testicular pain that resulted in orchiectomy were re-evaluated after a median follow-up of 7 years (range 2-15 years). The operative factors related to chronic testicular pain and atrophy were analysed using multiple regression analysis.
Altogether 62 urological complications (from 335 litigations) were recorded from 92,000 inguinal hernia operations. The distribution of claimed urological complications consisted of 34 testicular injuries, ten bladder perforations, seven massive scrotal haemorrhage or 11 miscellaneous injuries. Seventeen atrophic testes were left in situ and 17 (six early < 7 days, 11 late > 8 days) orchiectomies were performed due to necrosis or chronic testicular pain syndrome. In the conservative group of moderate scrotal or testicular pain (n = 17), all patients had late pain symptoms (>8 days), but pain was not so severe that orchiectomy was attempted. Using a multivariate analysis, postoperative infections were associated with chronic testicular or scrotal pain and atrophy, but hospital status, surgeon's training level, laparoscopic or open operation, type of hernia or use of mesh did not correlate with testicular injuries. During follow-up, 11/17 (65%) patients with orchiectomy were free of testicular pain.
Urological injuries form one-fifth of the major complications after inguinal hernioplasty. Orchiectomy appears to help the majority of patients with severe testicular pain syndrome.
腹股沟疝修补术后睾丸缺血和坏死是罕见的并发症。我们的目的是评估芬兰成人腹股沟疝手术相关严重泌尿系统并发症的发生率，特别是睾丸切除术在缓解顽固性慢性睾丸痛中的作用。
从芬兰患者保险中心分析 2003-2010 年与腹股沟疝手术相关的所有泌尿系统并发症。对因顽固性慢性阴囊或睾丸痛而接受睾丸切除术的患者进行中位随访 7 年（2-15 年）后的重新评估。使用多元回归分析来分析与慢性睾丸痛和萎缩相关的手术因素。
在 92000 例腹股沟疝手术中，共记录了 62 例泌尿系统并发症（335 例诉讼）。索赔的泌尿系统并发症分布为 34 例睾丸损伤、10 例膀胱穿孔、7 例巨大阴囊血肿或 11 例其他损伤。17 例萎缩睾丸保留在原位，17 例（6 例早期<7 天，11 例晚期>8 天）因坏死或慢性睾丸痛综合征行睾丸切除术。在中度阴囊或睾丸痛的保守组（n=17）中，所有患者均有晚期疼痛症状（>8 天），但疼痛并不严重，未尝试行睾丸切除术。多元分析显示，术后感染与慢性睾丸或阴囊痛和萎缩有关，但医院状况、外科医生的培训水平、腹腔镜或开放手术、疝的类型或网片的使用与睾丸损伤无关。随访期间，17 例睾丸切除术患者中有 11 例（65%）无睾丸痛。
泌尿系统损伤是腹股沟疝修补术后主要并发症的五分之一。睾丸切除术似乎有助于大多数严重睾丸痛综合征患者。
