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Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre

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A Comment to this article was published on 18 October 2013

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

The technical assistance of Mrs. Saija Lehtinen and Mrs. Pirjo Halonen (bio-statistical analysis) are greatly acknowledged. The experiments comply with the current laws of Finland.

Conflict of interest

Kirsi Rönkä, Jaana Vironen, Hannu Kokki, Tapani Liukkonen and Hannu Paajanen declare no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Kuopio University Hospital, 70211, Kuopio, Finland

    K. Rönkä & H. Paajanen

  2. Department of Surgery, Helsinki University Hospital, Helsinki, Finland

    J. Vironen

  3. Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland

    H. Kokki

  4. Department of Anaesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland

    H. Kokki

  5. Department of Surgery and Urology, Central Hospital of Mikkeli, Mikkeli, Finland

    T. Liukkonen & H. Paajanen

Authors
  1. K. Rönkä
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  2. J. Vironen
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  3. H. Kokki
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  4. T. Liukkonen
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  5. H. Paajanen
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Corresponding author

Correspondence to H. Paajanen.

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Rönkä, K., Vironen, J., Kokki, H. et al. Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre. Hernia 19, 53–59 (2015). https://doi.org/10.1007/s10029-013-1150-3

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  • DOI: https://doi.org/10.1007/s10029-013-1150-3

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