The state of blood flow in the spermatic cord vessel in men with inguinal hernia: a clinical and ultrasonic study and correction of testicular dysfunction

Objective: to evaluate testicular function and blood flow in the spermatic cord vessels and testicle in men with inguinal hernia (IH) before and after surgery.
Materials and methods. This prospective study included 60 men with unilateral IH and 30 healthy volunteers. All participants underwent color duplex ultrasonography of the spermatic cord and testicular vessels using a modified technique by I.I. Uspensky. The following parameters were measured: peak systolic velocity (PSV), mean flow velocity (Mean), resistance index (RI), and retrograde venous flow (V ven). In a subgroup of patients (n = 40) and controls (n = 20), circulating sex hormone levels were measured, and semen analysis was performed in 35 patients. Markers of oxidative endotoxemia (MDA, DC) and a marker of hypoxia (lactate) were measured in both serum and testicular venous blood from.
Results. The mean arterial flow velocity on the affected side was significantly lower (11.28 [10.2–12.5] cm/s) than on the contralateral side (14.08 [12.3–15.8] cm/s; p < 0.001) and in healthy volunteers (15.22 [14.5–16.3] cm/s; p < 0.001). A direct correlation was found between hernia size and the degree of blood flow reduction, as well as between the duration of hernia presence and the degree of vascular impairment. Semen parameters and serum testosterone levels decreased in patients with inguinal hernias, especially those with longer duration and larger defects. Markers of oxidative stress and hypoxia were elevated in testicular venous blood. Postoperative follow-up showed improvement in testicular perfusion and function, which was most pronounced after laparoscopic or hybrid hernia repair.
Conclusions. An inguinal hernia in men of reproductive age disrupts blood flow in the spermatic cord and testicular parenchyma vessels, which decreases spermatogenesis and testosterone production. The severity of the changes correlates with the size and duration of the hernia. The underlying causes of this dysfunction are ischemia, hypoxia, and oxidative stress. Atraumatic laparoscopic hernioplasty with intraoperative perfusion control, supplemented by an algorithm for selecting the surgical method and a plan for preventing postoperative testicular dysfunction, reliably restores blood flow and preserves reproductive potential.

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