Cremasteric reflex in neurectomy question

[Chaunce1234]

quote Bure96:

I had a my repair done at Shouldice and my testicles still shrink up when I’m cold and hang loose when I’m hot. I honestly haven’t noticed much, if any, difference in that regard.

This is great to report, indicating that whatever Shouldice does will not have a serious impact on normal anatomical function.

Additionally, I believe the scrotum itself has a separate mechanism of raising and lowering that is not related to the cremaster muscle/nerve branch, so that could be why a proper Shouldice repair has no apparent impact on whether testicles are appropriately responding to temperature differences. Alas I am not a doctor so I could be wrong about the precise anatomical functions and nerve branches.

On a somewhat unrelated note, it might be an interesting conversation topic if you [USER=”2600″]Bure96[/USER] were to report your specific experience with Shouldice and the repair, any outcome, thoughts, etc. I am sure many would be interested in reading it, and it could help other patients.

[Bure96]

quote Chaunce1234:

I believe it is standard for the Shouldice repair to cut the entire cresmasteric muscle, which presumably removes its functionality and reflex even if the nerve is intact. One might think if it was a problem then Shouldice would have addressed it, but they may have something specific to their method that avoids that.

I think I recall reading at one point that at Shouldice they ‘pin’ the remainder of the cremaster muscle up so that a testicle does not dangle too far, but a surgeon who performs the procedure would be a much better resource to discuss this, and whether it may relate to neurectomy?

I had a my repair done at Shouldice and my testicles still shrink up when I’m cold and hang loose when I’m hot. I honestly haven’t noticed much, if any, difference in that regard.

[paco]

Yes Chaunce, good note, you’re right. I had not realize.

Maybe my surgeon warmed me for such reason, not just related exclusively by neurectomy but the Shouldice repair that he intend to perform after removal.

In any case my concern is about how is living without cremasteric reflex, due it is a protective mechanism against twisting (and torsion) and its repercusion when running or jogging.

Thanks

[Chaunce1234]

I believe it is standard for the Shouldice repair to cut the entire cresmasteric muscle, which presumably removes its functionality and reflex even if the nerve is intact. One might think if it was a problem then Shouldice would have addressed it, but they may have something specific to their method that avoids that.

I think I recall reading at one point that at Shouldice they ‘pin’ the remainder of the cremaster muscle up so that a testicle does not dangle too far, but a surgeon who performs the procedure would be a much better resource to discuss this, and whether it may relate to neurectomy?

[Good intentions]

Hello paco. I had mesh removed from both sides, via TAP laparoscopy, and everything functions as it is supposed to afterward. I have full functionality and can run and work, although to a lower level than before my hernia. Full healing is taking some time.

I think that Dr. Billing left as much of the nerves, veins, arteries, etc., intact as he could. He did have to remove part of the epigastric artery because it was entangled and couldn’t be saved. He made a note of that in his post-operative report so I assume that he would have made note of any other important structure that had to be removed or was damaged. That was the only note he made about cutting something that would best be left alone.

So, in short, I don’t think that neurectomies are necessary for successful mesh removal. It probably depends on how entangled they are with the mesh that needs removing. I was probably lucky. It’s the judgment of the surgeon at the time of the surgery, I believe. One reason that robotic surgery seems to be gaining popularity for mesh removal, apparently, because the fine work necessary to save those structures can be accomplished with better success.

Good luck.