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Testicular atrophy following inguinal hernia repair in children

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Abstract

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 \(\le\) 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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Funding

This project was funded in part by the Henry M. Jackson Foundation for the Advancement of Military Medicine through a grant from the Department of Defense (DoD). WJ and AHH receive partial salary support. The funding source did not have a role in the collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department 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

    Kristin A. Sonderman, Lindsey L. Wolf, Wei Jiang & Adil H. Haider

  2. Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Kristin A. Sonderman, Lindsey L. Wolf & Adil H. Haider

  3. Department of Surgery, Boston Children’s Hospital, Boston, MA, USA

    Lindsey B. Armstrong, Brent R. Weil, Christopher B. Weldon & Samuel E. Rice-Townsend

  4. Harvard Medical School, Boston, MA, USA

    Kathryn Taylor

  5. Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Tracey P. Koehlmoos & Robert L. Ricca

Authors
  1. Kristin A. Sonderman
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  2. Lindsey L. Wolf
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  3. Lindsey B. Armstrong
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  4. Kathryn Taylor
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  5. Wei Jiang
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  6. Brent R. Weil
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  7. Tracey P. Koehlmoos
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  8. Robert L. Ricca
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  9. Christopher B. Weldon
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  10. Adil H. Haider
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  11. Samuel E. Rice-Townsend
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Corresponding author

Correspondence to Kristin A. Sonderman.

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Conflict of interest

Dr. Adil Haider: Supported by the Henry M. Jackson Foundation HU0001-11-1- 0023 and the comparative effectiveness and provider induced demand collaboration (EPIC): A clinical and economic analysis of variation in healthcare. The Center for Surgery and Public Health and the Uniformed Services University of Health Sciences are jointly supported by the Henry M. Jackson Foundation for the Advancement of Military Medicine to provide protected research efforts involving the analysis and study of military TRICARE data. AHH receives partial salary support. AHH is the Principal Investigator (PI) of the joint study; he also serves on the Institute of Medicine’s Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector Committee. Not related to this work, AHH is the PI of a contract (AD-1306-03980) with the Patient-Centered Outcomes Research Institute entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED” and a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled “Mitigating Disparities Through Enhancing Surgeons’ Ability To Provide Culturally Relevant Care.” Conflict of Interest: Not related to this work, AHH is the co-founder and an equity holder in Patient Doctor Technologies Inc., which owns and operates the website http://www.doctella.com.

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The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.

Appendix

Appendix

See Table 5.

Table 5 ICD-9CM diagnosis, ICD-9CM procedure, and CPT codes used to define prematurity, inguinal hernia repair and outcome of testicular atrophy
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Sonderman, K.A., Wolf, L.L., Armstrong, L.B. et al. Testicular atrophy following inguinal hernia repair in children. Pediatr Surg Int 34, 553–560 (2018). https://doi.org/10.1007/s00383-018-4255-z

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