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Biomedical subjects

G E Lemack

Publications and source records attributed to G E Lemack.

At least 19 recordsLinked to original sources
PubMed2001

Standing cystourethrogram: an outcome measure after anti-incontinence procedures and cystocele repair in women.

OBJECTIVES: To evaluate the standing voiding cystourethrogram (VCUG) with lateral views as an outcome measure to objectively document the correction of the urethral angle and cystocele in women who underwent various types of pelvic surgery. METHODS: A control group of 76 continent patients was selected who had VCUGs performed for indications other than incontinence. Patients with preoperative and postoperative VCUGs after anterior vaginal wall suspension for urethral hypermobility and grade 1 or 2 cystocele (UH group) or repair of grade 3 cystocele (C group) were selected and compared with age-matched controls from the control group. RESULTS: Among the control group, the mean +/- SD urethral angle at rest was 12.5 degrees +/- 13.1 degrees and the urethral angle at straining was 24.7 degrees +/- 15.6 degrees (P <0.001). The urethral angle at rest increased significantly from women in their 20s to their 80s. In the UH group (n = 52), the preoperative mean urethral angle at rest and at straining was 25.7 degrees +/- 13.6 degrees and 42.6 degrees +/- 15.9 degrees, respectively, a difference of approximately 20 degrees. The postoperative urethral angles at rest and at straining did not statistically differ from those of the age-matched controls. In the C group (n = 36), the postoperative urethral angle at rest did not statistically differ from that of the age-matched controls. The lateral height of the cystocele demonstrated significant improvement in the UH and C groups. CONCLUSIONS: The standing VCUG is a reproducible outcome measure to preoperatively and postoperatively document the urethral angle. Using age-matched controls, a more objective definition of urethral hypermobility was obtained. Changes in cystocele height were observed postoperatively with a return to comparable age-matched control values.

Adult↗
PubMed2001

Contractile protein expression in bladder smooth muscle is a marker of phenotypic modulation after outlet obstruction in the rabbit model.

PURPOSE: We determined changes in contractile protein expression before and after the relief of partial bladder outlet obstruction in the rabbit model and assessed their potential role as predictors of recovery. MATERIALS AND METHODS: We examined the ratio of the smooth muscle myosin heavy chain isoforms SM2-to-SM1, caldesmon isoform expression and bladder function in obstructed and unobstructed adult rabbit bladders. Cystometry, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analysis were done to determine changes in bladder function and contractile protein expression. RESULTS: Overall we observed significant correlation of bladder weight with the SM2-to-SM1 ratio (p <0.05). Regardless of the duration of obstruction (up to 10 weeks) the ratio appeared to stabilize around a value comparable to that in fetal rabbit smooth muscle cells, suggesting a reversal of SM2 and SM1 expression to a level similar to that at the fetal stage. The pattern of h and l-caldesmon isoform expression showed an increase in l-caldesmon expression in obstructed bladders. Except for decreased leak point pressure in the obstructed group we noted no statistically significant urodynamic changes in bladder capacity or compliance. CONCLUSIONS: There is significant correlation of bladder weight, which is the best known marker of obstruction, with the SM2-to-SM1 ratio. The myosin heavy chain isoform expression ratio appears to be an indicator of phenotypic modulation in bladder smooth muscle before and after the relief of bladder outlet obstruction. Thus, it may be useful as a marker of bladder dysfunction and predictor of functional recovery. Regression to a fetal pattern of protein expression may suggest irreversible damage to smooth muscle cells, possibly limiting recovery.

Animals↗
PubMed2001

Up-regulation of a gene homologous to the human tumor necrosis factor receptor associated factor 6 gene in the obstructed rabbit bladder determined by differential display polymerase chain reaction.

PURPOSE: We identified differentially expressed genes in the rabbit bladder after partial outlet obstruction. MATERIALS AND METHODS: Differential display polymerase chain reaction (PCR) was performed on smooth muscle tissue from normal, 2 and 6-week obstructed rabbit bladders. Semiquantitative reverse transcriptase PCR, Western and RNA blot analysis were done to confirm messenger RNA and protein up-regulation. RESULTS: A signal transducing protein human tumor necrosis factor receptor associated factor 6 (TRAF6)-like protein was identified on differential display PCR. TRAF6-like protein was up-regulated in rabbit bladders after 2 weeks of partial outlet obstruction. Reverse transcriptase PCR demonstrated TRAF6-like protein in bladder muscle tissue and semiquantitative analysis confirmed up-regulation in 2-week obstructed tissue. These findings were confirmed by RNA and Western blot analysis. CONCLUSIONS: TRAF6-like protein is up-regulated during the early phase of bladder outlet obstruction in rabbits. To our knowledge involvement of this gene in bladder outlet obstruction has not been described previously. TRAF6 may have a role in the regulation of molecular changes during the early bladder response to outlet obstruction, such as the up-regulation of growth factors and proto-oncogenes. Further understanding of this signaling pathway and its role in bladder outlet obstruction may open new avenues for treating detrusor dysfunction.

Animals↗
PubMed2001

Overactive bladder: optimizing quality of care.

Overactive bladder (OAB), the symptom complex of urinary urgency and frequency with or without urge incontinence, affects the lives of millions of Americans. In recent years, more successful treatment options have emerged as advances have been made in understanding the pathophysiologic processes underlying OAB symptoms. However, because most therapeutic modalities for OAB are aimed at symptom resolution, rather than the treatment of distinct pathologic entities, a basic evaluation is required for all patients to establish whether existing (and treatable) pathologic processes are present. In the absence of these processes, symptom relief is both the objective and the outcome used to judge the efficacy of a specific modality. The type of therapy recommended for OAB may depend on several factors including age, existing behavioral patterns, estrogen status, degree of motivation, environmental surroundings, presence of other coexisting urinary symptoms, family support, and patient expectations. This article focuses on methods of identifying patients with OAB, and the role of developing strategies in treating this common disorder.

Aged↗
PubMed2001

[Interstitial cystitis: reevaluation of patients who do no respond to standard treatments].

OBJECTIVE: Insterstitital cystitis (IC) is an uncommon disease without an existing positive diagnostic test. Our experience has been that it tends to be overly considered, with many patients treated for long periods with several different regimens and no improvement. This impression prompted a review of our recent experience in the exclusionary diagnosis of IC. MATERIAL AND METHODS: A retrospective review of patients referred to our specialty clinic between December 1995 and October 1998 revealed 23 patients (21 women, 2 men) who had been diagnosed with IC, and had received at least one treatment for this disease (intravesical DMSO or Heparin, Elmiron, 1-Arginine, or therapeutic hydrodistension) with little or no benefit. Our own evaluation of these patients included urinalysis, non-invasive uroflow, post void residual determination and office cystoscopy (all patients), filling cystometrogram and pressure-flow-EMG studies (21 patients), voiding cystourethrogram (17 patients), urethral MRI (9 patients), and other studies as indicated. The results of our reevaluation are reported. RESULTS: Of the 23 patients referred with a diagnosis of IC, only 4 were considered to meet the diagnostic criteria as established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) after a thorough evaluation. One other patient did not meet the criteria but responded to medications for IC. Urethral pathology was a common finding (distal periurethral fibrosis causing obstruction in 5 patients, intraurethral wall diverticulum in 2, and chronic urethritis in 2), particularly among women with abnormal pressure flow studies during urodynamics. CONCLUSIONS: In our experience, many patients who carried the diagnosis of interstitial cystitis were found to have other causes contributing to their urinary symptoms after careful reassessment. Urodynamic studies were found to be of paramount importance in excluding the diagnosis in many cases. On the basis of our findings, we recommend that if local urethral tenderness is noted on physical examination or an abnormal pressure-flow relationship is seen during urodynamics, further investigation is warranted.

Adult↗
PubMed2000

The levator myorraphy repair for vaginal vault prolapse.

Various techniques have been described for the repair of vaginal vault prolapse after hysterectomy. Because of inherent difficulties associated with the sacrospinous fixation, a new repair, the levator myorraphy, was devised to simplify reconstruction of the pelvic floor 10 years ago. This repair results in a restored vaginal axis and prevention of posterior enterocele recurrence by recreating the levator shelf high within the peritoneal cavity and fixing the vault in that position. Because this procedure can be performed from a vaginal approach, morbidity is minimized. Over this 10-year time period, we have performed the levator myorraphy in over 120 women. We believe this approach can be easily taught, is highly effective, and results in a repair that most closely restores the normal anatomic position.

Female↗
PubMed2000

Transvaginal repair of postcystectomy peritoneovaginal fistulae.

To our knowledge, peritoneovaginal fistula is a complication of cystectomy that has not been reported before. We describe 2 patients in whom a transvaginal approach using a Martius flap was utilized to repair persistent vaginal leakage after cystectomy. At a mean follow-up of 20 months, both patients are free from vaginal leakage and have no evidence of recurrent fistula. This approach offers a safe and effective way to repair a peritoneovaginal fistula in a cystectomy patient.

Cystectomy↗
PubMed2000

Sexual function after vaginal surgery for stress incontinence: results of a mailed questionnaire.

OBJECTIVES: To address the issue of sexual dysfunction after vaginal surgery for incontinence based on responses to a mailed questionnaire. METHODS: A sexual function questionnaire was mailed to 93 women who underwent anterior vaginal wall suspension for stress urinary incontinence alone (group 1) or in conjunction with a concomitant posterior repair (group 2) at least 1 year previously. RESULTS: A total of 56 (60%) women responded. Following surgery, 10 (37%) women in group 1 reported themselves as sexually active and 12 (41%) in group 2, which was similar to preoperative values. Only 1 woman in group 1 and 3 women in group 2 attributed their sexual inactivity to their own lack of desire or inability to have intercourse. Overall, 20% of women noted pain during intercourse, a finding slightly lower than the preoperative incidence (29%). No difference in the incidence of dyspareunia was noted between groups. Still, several women (18%) reported intercourse to be worse following surgery. Women who were either premenopausal or on hormone replacement therapy were more likely to be sexually active following surgery (46%) than those not on hormone replacement (17%). CONCLUSIONS: Overall, the percentage of women who were sexually active did not appear to be affected by a vaginal suspension procedure for incontinence. Symptomatic vaginal narrowing was rare, even among women undergoing simultaneous posterior repair. Still, nearly 20% of women considered intercourse to be worse postoperatively, although not all women reported dyspareunia. The possible causes for postoperative sexual dysfunction require further investigation.

Adult↗
PubMed2000

Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson's disease.

OBJECTIVES: To assess the lower urinary tract symptoms (LUTS) in men and women with mild to moderate Parkinson's disease (PD) using validated symptom questionnaires. METHODS: Eighty men and 39 women with mild to moderate PD (Hoehn and Yahr score less than 3) were mailed LUTS questionnaires to complete and return. Men received the American Urological Association Symptom Index and women received the Urogenital Distress Inventory-6. Patients not responding by mail were called and asked to complete the survey over the telephone. Control populations of both symptomatic and asymptomatic men and women (without PD) were identified for comparison. RESULTS: The overall response rate was 78%. Men with early-stage PD had higher American Urological Association Symptom Index scores than age-matched controls (total score of 12.0 versus 7.7, P <0.05) and scores similar to those reported for men with symptomatic benign prostatic hyperplasia (12.5). Specific items noted to be higher among the men with PD included questions regarding frequency and urgency. Women with PD had higher scores on the Urogenital Distress Inventory-6 than non-age-matched controls (total score of 4.8 versus 2.1, P <0.05), but lower scores than an age-matched group of neurologically intact women presenting for urologic evaluation of LUTS (6.9, P <0.05). CONCLUSIONS: On the basis of the responses to the validated symptom indexes, the development of LUTS appears to occur at an earlier stage of PD than was once appreciated. Prompt evaluation and treatment of patients with lower urinary tract complaints in the setting of PD may identify bladder dysfunction at an earlier, more treatable stage.

Adult↗
PubMed2000

Identifying patients who require urodynamic testing before surgery for stress incontinence based on questionnaire information and surgical history.

OBJECTIVES: To determine whether knowledge about previous surgical history for incontinence and responses to a validated lower urinary tract symptom questionnaire for women could identify those who should undergo urodynamic testing before surgery for stress urinary incontinence (SUI). METHODS: A retrospective analysis of all women who completed the Urogenital Distress Inventory-6 questionnaire (UDI-6) and then underwent complete urodynamic studies was conducted. The critical urodynamic diagnoses to determine before anti-incontinence surgery were defined as coexisting SUI and detrusor instability (DI), Valsalva leak point pressure less than 60 cm H(2)O, and DI alone in women suspected clinically of having SUI. Models were established for deciding who should undergo urodynamic studies on the basis of questionnaire responses and information about previous surgical history. Cost savings and the ability of the various models to identify patients with critical urodynamic diagnoses were calculated. RESULTS: A total of 174 women completed the UDI-6 and underwent urodynamics studies. Sixty-two had SUI (36%), 54 had DI (31%), 18 had both SUI and DI (10%), and 19 women suspected of having SUI were found instead to have DI (11%). Among women with SUI, 39 had a Valsalva leak point pressure less than 60 cm H(2)O (63%). No group of question responses or combination of question responses and presence of previous incontinence surgery was able to identify all three critical urodynamic diagnoses with statistical significance. Still, the combination of a response of "2" or "3" to question 3 on the UDI-6 and a positive history of previous surgery would have identified 91% of the critical diagnoses, and a substantial cost savings would have been realized. CONCLUSIONS: Using the UDI-6 and information obtained from the patient's history to determine who should undergo urodynamic testing before surgery for SUI can result in substantial cost savings without sacrificing patient care.

Adult↗
PubMed2000

Pressure flow analysis may aid in identifying women with outflow obstruction.

PURPOSE: We refined recently developed pressure flow cutoff values for female bladder outlet obstruction and applied these values in a consecutive group of women undergoing urodynamic testing for various lower urinary tract symptoms. MATERIALS AND METHODS: A total of 87 women with clinical obstruction determined by history and presenting complaint were enrolled in our prospective evaluation of pressure flow studies. We identified 3 groups of participants according to the suspected cause of obstruction, including prolapse in 33, previous incontinence surgery in 25, and no likely source of obstruction identified from history and physical examination only in 29. An additional 124 patients presenting for evaluation of stress urinary incontinence served as controls. Optimal cutoff values for determining obstruction were developed using receiver operating characteristic curves. To determine the prevalence of bladder outlet obstruction these values were prospectively applied to 106 women undergoing urodynamics for various voiding complaints. RESULTS: In controls the average maximum flow rate was 23 cc per second and average detrusor pressure was 21.9 cm. water, whereas the corresponding values in those with clinical obstruction were 10.7 cc per second and 40.8 cm. water (p <0.001). No differences were noted in the various obstruction groups. Receiver operating characteristics analysis revealed that cutoff values of 11 cc per second or less and 21 cm. water or more optimized the selection of patients with bladder outlet obstruction. Using these values we noted a bladder outlet obstruction prevalence of 20% in a consecutive cohort of women undergoing urodynamic studies at our center. CONCLUSIONS: We propose cutoff pressure flow values for identifying women with bladder outlet obstruction although they should be used only in conjunction with the overall clinical situation. Neither pressure flow data only nor clinical symptoms alone may be sufficient for diagnosing obstruction in women.

Female↗
PubMed2000

Altered response to partial bladder outlet obstruction in mice lacking inducible nitric oxide synthase.

INTRODUCTION: Following prolonged partial bladder outlet obstruction (BOO) in the mouse, cholinergic mediated detrusor contractility decreases. Previous work has demonstrated an increase in the inducible form of nitric oxide synthase (iNOS) at the mRNA and protein levels soon after obstruction. Since nitric oxide (NO), the product of the action of iNOS on molecular oxygen and l-arginine, produces vasodilation and decreases platelet aggregation, we believe it is an integral part of the initial detrusor response to obstruction. These experiments evaluated the detrusor response in mice incapable of producing iNOS. MATERIALS AND METHODS: Wild type and knockout mice were partially obstructed for 1, 3, and 5 weeks. Physiologic evaluation consisted of cystometric analyses, and muscle strip studies in response to cholinergic and electrical stimulation. Strips were also relaxed with L-arginine, sodium nitroprusside, and 8-bromoguanosine 3' - 5' cyclic GMP, after precontraction. RESULTS: After 5 weeks of obstruction, both wild type (WT) and knockout (KO) mouse bladders increased significantly in weight. WT bladders obstructed for 5 weeks had the greatest capacity (increase of 42%, p = 0.022), and a decreased contractile response to carbachol (decrease of 32% at 10-5 M, p = 0.018). No differences were noted at 1 and 3 weeks of obstruction. In contrast, KO mice had a significantly larger bladder capacity at 1 week of obstruction compared with WT, and had significantly lower responses to electrical stimulation than WT at the same time (p = 0.03). Additionally, after 5 weeks of obstruction, bladder capacity and contractility returned to baseline levels in KO mice, at a time when WT mice had significantly larger capacity and decreased contractility. CONCLUSIONS: Bladder function following partial BOO in mice incapable of producing iNOS differed significantly from the normal response. Our data suggest that generation of iNOS soon after obstruction is necessary to prevent detrusor dysfunction at that time. Moreover, the enhanced function seen in KO bladders after longer periods of obstruction (5 weeks) in comparison to WT bladders suggests that reactive nitrogen species-induced protein nitrosylation may be involved in the loss of contractile function observed after more prolonged periods of obstruction.

Animals↗
PubMed1999

Altered bladder function in transgenic mice expressing rat elastin.

The elasticity of tissues subjected to repeated deformation is provided by the presence of elastic fibers in the extracellular matrix (ECM). The most abundant component of elastic fibers is elastin, whose soluble precursor is tropoelastin. To establish the role elastin plays in the bladder, this study describes the biosynthetic, histologic, and physiologic consequences of expression of an isoform of rat tropoelastin in transgenic mouse bladder. The polymerase chain reaction (PCR) was used to determine expression of a rat tropoelastin minigene in transgenic mice. Histochemical methods were used to demonstrate changes in elastic fibers in frozen sections of bladder. Cystometric analysis was carried out in transgenic and non-transgenic mice, prior to and after 3 weeks of partial outlet obstruction. The PCR assay demonstrated that bladder tissue of transgenic mice expressed rat tropoelastin mRNA, whereas non-transgenes did not. Increased deposition of elastic fibers was demonstrated with the Verhoeff-van Gieson stain. Bladders of transgenic animals were more compliant than bladders of their non-transgenic littermates. Partial outlet obstruction resulted in increased bladder volume and more compliant bladders in non-transgenic mice. In contrast, the bladder volume and compliance in transgenes was almost unchanged by obstruction. This study demonstrates that normal elastic fiber assembly is prerequisite for the compliant properties of the bladder wall. Moreover, the response of the bladder to obstruction is critically influenced by elastin synthesis.

Animals↗
PubMed1999

Urethral dilation in women: a questionnaire-based analysis of practice patterns.

OBJECTIVES: To assess current practice patterns among urologists and to determine the perceived efficacy of urethral dilation. Urethral dilation has been advocated as a treatment for a variety of urologic disorders in women for several decades. Recent changes in Medicare reimbursement have again focused attention on this issue. METHODS: A 15-item questionnaire was mailed to all urologists actively practicing in the state of Texas (n = 642). The questionnaire consisted of 12 items about indications for, technique of, and outcome of urethral dilation, and three demographic questions regarding location and type of practice and number of years since completing residency. RESULTS: A total of 194 physicians completed and returned the questionnaire (30%). Overall, 48.2% of practitioners used dilation six or fewer times during the past year; 23.7% reported having used it more than 30 times. Most urologists used dilation for urethral syndrome only (61.1%), although urethral stricture was also a frequently reported condition requiring dilation (29%). Most urologists trained within the past decade (60.9%) reported never offering dilation for urethral syndrome; only 34.2% of the remainder never offered it (P = 0.002). Urologists normally performed this procedure with local or no anesthesia (85%) and most commonly dilated to 32F (45%). Overall, 21% of urologists trained more than 10 years ago considered dilation very or extremely successful in treating urethral syndrome; 0 of 42 trained more recently considered it to be this successful (P = 0.014). CONCLUSIONS: The use of urethral dilation in women remains controversial. Recently trained urologists use it less frequently and find it less efficacious than those who have been practicing for longer periods. Since such obvious biases exist, it is imperative that the clinical merit of urethral dilation be carefully scrutinized.

Catheterization↗
PubMed1999

Predictability of urodynamic findings based on the Urogenital Distress Inventory-6 questionnaire.

OBJECTIVES: The Urogenital Distress Inventory (UDI-6) is a validated 6-item questionnaire that assesses lower urinary tract symptoms, including incontinence, in women. Similar indexes developed in men to evaluate symptoms of benign prostatic hyperplasia have failed to show a relationship with urodynamic (UD) parameters indicating bladder outlet obstruction (BOO). In this study, we sought to determine whether UDI-6 responses could predict information obtained during UD evaluations. METHODS: All women referred to our clinic with lower urinary tract complaints who completed a UDI-6 questionnaire and subsequently underwent UD evaluation were included (n = 128). UD findings used for analysis included Valsalva leak point pressure (VLPP), maximum flow rate (Qmax), and detrusor pressure at Qmax (PdetQmax). BOO was defined as Qmax of 1 5 mL/s or less and PdetQmax of greater than 20 cm H2O; detrusor overactivity (DO) was defined as any rise in detrusor pressure associated with urge during filling. RESULTS: The most common chief complaints were incontinence (mixed, 26.6%; stress, 20.3%; and urge, 13.3%), urgency/frequency (14.1%), and symptomatic prolapse (10.1%). There was a moderate correlation between a positive response to question 3 (stress urinary incontinence [SUI]) and leakage with strain or cough during UD evaluation (correlation coefficient = 0.51). In fact, most patients answering that SUI was moderately or greatly bothersome were found to have stress-induced leakage during the UD evaluation (82%), which differed significantly from those who reported no bother (Fisher's exact test, P = 0.0006). Severity of leakage assessed by VLPP, however, did not correlate with the severity assessed by any question. With regard to BOO in women, most patients who answered that incomplete emptying was their most bothersome symptom had BOO (61%), and most women with a different main complaint were unobstructed (73%, P <0.002). Finally, 30 of 36 women who answered that leakage related to urgency was moderately or greatly bothersome were found to have DO, which was significantly different than the incidence of DO in women who did not report this complaint (correlation coefficient = 0.38, P <0.001). CONCLUSIONS: Unlike similar indexes used to assess lower urinary tract symptoms in men, specific items from the UDI-6 may provide predictive information regarding UD findings in women, particularly with regard to SUI, BOO, and DO. However, if VLPP is considered vital to planning treatment, UD studies will still be required, since no question could estimate the severity of incontinence as determined by serial VLPP measurement.

Adult↗
PubMed1999

Physiologic sequelae of partial infravesical obstruction in the mouse: role of inducible nitric oxide synthase.

PURPOSE: To develop a mouse model for partial infravesical obstruction, and determine the resultant changes in bladder function, with particular emphasis on the role of inducible nitric oxide synthase (iNOS) in the bladder response. MATERIALS AND METHODS: Wild type mice were subjected to no intervention, sham operation, and varying durations of partial outlet obstruction (1, 3, and 5 weeks). They then underwent cystometric evaluation, bladder strip stimulation studies using carbachol, and relaxation studies using l-arginine, sodium nitroprusside, and 8-bromoguanosine 3'-5' cyclic guanosine monophosphate. Bladder tissue was subjected to RT-PCR and Western analysis for iNOS. Bladders were also studied histologically using morphometric analysis. RESULTS: Bladders from mice obstructed for 5 weeks were heavier (weight increased by 110%), larger (capacity increased by 73%), and had a higher frequency of abnormal appearing cystometric curves than normal bladders. Tissue bath studies demonstrated decreased contractility in response to cholinergic stimulation at 5 weeks of obstruction (decreased by 55% at maximal stimulation). RT-PCR demonstrated iNOS in approximately 70% of bladders obstructed for 1 and 3 weeks, while the iNOS protein was apparent in 50% of the bladders from the same groups. CONCLUSIONS: This new animal model of infravesical obstruction is reliable and reproducible. Moreover, the physiologic changes noted are comparable to other models, but an added advantage is the relevance of this model with regard to studying new transgenic or knockout mice. Enhanced expression of iNOS seen early after obstruction may serve to improve oxygenation during obstruction-induced ischemia.

Animals↗
PubMed1999

The effects of mesh bioprosthesis on the spermatic cord structures: a preliminary report in a canine model.

PURPOSE: The use of mesh bioprosthesis during inguinal herniorrhaphy is now considered routine. To our knowledge, no studies have examined the effects of mesh induced fibrosis on the structure and function of the adjacent spermatic cord. We present our experience in a canine model. MATERIALS AND METHODS: Unilateral inguinal hernia defects were created in 12 male beagle dogs. Half were repaired using Marlex mesh and half using a classic Shouldice technique. The inguinal anatomy was then re-examined at 6 and 12 months. Testicular temperature and volume, peripheral and testicular vein testosterone levels, testicular blood flow, vasography, testicular and cord histology, and sperm motility/morphology were recorded. Groups were compared with each other as well as to the non-operated (control) side. RESULTS: Although post-operative testicular volumes from both the mesh and Shouldice groups were similar to controls (p >0.05), there was a downward trend after mesh repair (17.8 cc pre versus 12.6 cc post) but this did not reach statistical significance (p = 0.17). Testicular temperatures and blood flow did not differ between experimental groups and controls. While testicular vein testosterone levels were significantly higher than peripheral venous levels after Shouldice repair, this difference was lost after mesh repair. Contralateral (control) testicular vein testosterone levels were higher in animals repaired with mesh than by an anatomic Shouldice repair (p <0.05). There was a significant decrease in cross sectional vasal luminal diameter in both the anatomic and mesh repair groups versus their respective contralateral controls (p <0.05). This was correlated with a marked foreign body reaction to the mesh in the soft tissues surrounding the vas in spermatic cords exposed to Marlex. All vasograms demonstrated patency. Gross pathology was abnormal in 3/6 dogs with mesh repair (2 hydroceles and 1 ischemic testis) and 0/6 animals after Shouldice repair. A traumatic neuroma was identified in the mesh group. Sperm morphology and motility did not differ between the two groups. CONCLUSIONS: Half of the testicles had gross abnormalities after mesh repair versus none in the control and Shouldice dogs. Although all vasograms were patent, vasal luminal size was significantly decreased with a marked soft tissue foreign body reaction identified after mesh repair. A traumatic neuroma was identified suggesting nerve entrapment in the fibrotic mesh reaction, which may account for post-operative pain seen in some patients. Marlex mesh may adversely affect spermatic cord structure and function and further work is required to fully elucidate its effects.

Animals↗