A Pathology of Mesh and Time
Bibliographic record
Abstract
OBJECTIVE: The ubiquitous use of polypropylene mesh in hernia surgery has spawned a new clinical syndrome: chronic post-herniorrhaphy neuralgia. A subset of that clinical picture is dysejaculation, sexual pain, and orchialgia. We propose to identify the processes that lead to that pain. SUMMARY OF BACKGROUND DATA: Specimens of vas adherent to polypropylene mesh, explanted in an attempt to control severe, life-changing inguinodynia are extremely difficult to obtain. This scarcity may be due to ingrained attitudes in our society about removal of vas and/or testicles for whatever reason. Attempts at preserving such damaged structures may paradoxically contribute to the chronicity and severity of such pain. METHODS: The medical files of patients who had mesh specimens explanted because of severe chronic post-herniorrhaphy pain were reviewed to identify cases with recorded evidence, at the time of surgery, of involvement of spermatic cord/vas deferens with mesh. These criteria were met in 13 cases and the specimens were analyzed histologically. RESULTS: The vas deferens was resected in 83% (5 of 6) of the patients with a history of sexual pain and/or dysejaculation (vs 14% of those without a history of sexual pain, P = 0.03). Histology demonstrated unequivocal mesh invasion of the spermatic cord, where the initial damage occurred to nerves (autonomic, somatic), then to the smooth muscle of the vas while the lumen remained patent. In 50% (3 of 6), the vas and other cord structures appeared to be completely invaded by the mesh and replaced by scar tissue. CONCLUSIONS: Irreversible damage of the nerves and vas musculature due to mesh migration is one of the mechanisms for sexual pain and dysejaculation. Attempts at all cost to preserve elements of the spermatic cord may not be justified in cases of severe pain, especially sexual pain (and/or dysejaculation) and intraoperative finding of cord involvement by the mesh. Vasectomy with mesh removal may well be indicated and be considered not a radical procedure but a conservative measure given the severity of the pain!
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".