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Testicular atrophy following inguinal hernia repair in children
Kristin A Sonderman1,2, Lindsey L Wolf3,4, Lindsey B Armstrong5
1Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA. kojomo@bwh.harvard.edu.
Insights
Testicular atrophy is a rare complication after pediatric inguinal hernia repair, occurring most often in younger children and those with an undescended testis. Diagnosis can occur years after the initial surgery.
Area of Science:
- Pediatric Surgery
- Urology
- Clinical Outcomes Research
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Testicular atrophy is a potential, though uncommon, complication.
- Understanding the incidence and timing of this complication is crucial for patient counseling and follow-up.
Purpose of the Study:
- To determine the incidence and timing of testicular atrophy following inguinal hernia repair in children.
- To identify risk factors, such as age and presence of an undescended testis, associated with testicular atrophy.
Main Methods:
- Retrospective analysis of the TRICARE database (2005-2014) for male children under 12 years undergoing inguinal hernia repair.
- Exclusion of patients with prior testicular atrophy, malignancy, or related operations.
- Primary outcome: incidence of testicular atrophy diagnosis; secondary outcome: time to diagnosis, stratified by age and undescended testis status.
Main Results:
- 8,897 children met inclusion criteria; median follow-up was 3.57 years.
- Overall incidence of testicular atrophy was 5.1 per 10,000 person-years.
- Highest incidence in children with an undescended testis (13.9/10,000 person-years) and those under 2 years old (72% of cases). Median time to diagnosis was 2.4 years.
Conclusions:
- Testicular atrophy is a rare but significant complication of pediatric inguinal hernia repair.
- Children under 2 years and those with an undescended testis are at the highest risk.
- Diagnosis of testicular atrophy can be delayed, occurring up to several years post-surgery.
Purpose:
We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children.
Methods:
We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including > 3 million children. We abstracted data on male children < 12 years who underwent inguinal hernia repair (2005-2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis.
Results:
8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1-5). Median follow-up was 3.57 years (IQR 1.69-6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children [Formula: see text] 5 years, with 72% in children < 2 years. Median time to atrophy was 2.4 years (IQR 0.64-3), with 30% occurring within 1 year and 75% within 3 years.
Conclusion:
Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later.
Level Of Evidence:
Prognosis Study, Level II.
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