Rapidly progressing, late-onset obstructive azoospermia linked to herniorrhaphy with mesh

Area of Science:

• Reproductive Medicine
• Surgical Innovation
• Male Infertility

Background:

• Inguinal herniorrhaphy with polypropylene mesh is a common surgical procedure.
• Long-term complications of mesh-based herniorrhaphy are not fully understood.
• Vas deferens obstruction is a potential, albeit rare, complication affecting male fertility.

Observation:

• A 30-year-old male presented with rapidly progressing bilateral vas deferens obstruction five years post-herniorrhaphy.
• The obstruction developed within months, leading to concerns about fertility.
• Diagnostic vasography confirmed the obstruction.

Findings:

• Testicular sperm extraction (TESE) successfully retrieved numerous motile sperm.
• Intracytoplasmic sperm injection (ICSI) using TESE-derived sperm is a viable option for achieving pregnancy.
• This case highlights the potential for delayed, progressive vasal obstruction after mesh herniorrhaphy.

Implications:

• Men undergoing inguinal herniorrhaphy with polypropylene mesh should be counseled on potential long-term reproductive risks.
• Sperm cryopreservation prior to irreversible azoospermia is advisable.
• TESE-ICSI offers a successful alternative for fertility restoration in cases of severe obstructive azoospermia post-herniorrhaphy.