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Testicular atrophy following inguinal hernia repair in children



We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children.


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.


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.


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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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.

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Correspondence to Kristin A. Sonderman.

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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

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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.



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).

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  • Testicular atrophy
  • Inguinal hernia complication
  • Pediatrics