Testicular atrophy as a risk inguinal hernioplasty.

In my experience, the complication of testicular atrophy after primary hernioplasty occurred only in patients in whom a complete indirect inguinal hernia sac was dissected from the spermatic cord. Avoiding this dissection by leaving the distal part of the sac in place reduces the incidence of the complication. All patients with scrotal inguinal hernias and all patients with recurrent inguinal hernias should have the complications of ischemic orchitis and testicular atrophy explained to them in depth because of the litigious nature of some of the men in whom this condition occurs. Patients who had undergone two or more operations for inguinal hernia should give prior written permission for orchiectomy even though this procedure is rarely necessary. In these patients, the performance of preperitoneal inguinal hernioplasty will permit the surgeon to avoid dissecting previously mobilized spermatic cords and should reduce the incidence of testicular atrophy in men fearful of this complication.