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Sources of Funding: None

Introduction

Previous studies reported that about 10% of patients who underwent retropubic radical prostatectomy developed inguinal hernia (IH) after surgery. However, few studies have evaluated IH following robot-assisted radical prostatectomy (RARP). We retrospectively investigated the incidence and risk factors for IH after RARP.

Methods

Subjects included patients who underwent RARP for prostate cancer in our institution from February 2012 to January 2015. Those with previous/concomitant IH history, concurrent IH-prophylaxis surgery, and follow-up < 1 year were excluded. Demographic and clinical profiles were collected from medical records. Every RARP video record was reviewed by a blinded urologist to verify the existence of a patent processus vaginalis (PPV). Univariate and multivariate Cox proportional hazards models were used to determine relationships between post-RARP IH and age, body mass index (BMI), previous lower abdominal surgery, total International Prostate Symptom Score (IPSS), IPSS voiding score, IPSS storage score, IPSS question 5 (weak stream) and 6 (straining) score, maximum urethral closing pressure (MUCP) and functional profile length (FPL) on urethral pressure profile, prostate weight, and PPV. Pre- and postoperative IPSS, MUCP, and FPL were included.

Results

Of 284 patients in the study, 41 (14.4%) developed IH at a median 8 months after RARP. On univariate analysis, BMI ≥ 23, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.24 - 0.89, p = 0.02; HR 2.20, 95% CI 1.12 - 4.3, p = 0.02; HR 3.59, 95% CI 2.39 - 5.40, p < 0.001, respectively). On multivariate analysis, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (HR 2.77, 95% CI 1.40 - 5.51, p = 0.003; HR 3.87, 95% CI 2.46 - 6.07, p < 0.001). PPV was detected on the right (51 patients, 17.9%), left (23, 8.0%), and both (15, 5.2%) sides._x000D_ Twenty-three of 51 patients (45.0%) with right-side PPV, 5 of 23 (26.0%) with left-side PPV, and 5 of 15 (33.3%) with bilateral PPV developed IH after RARP._x000D_ Thirty-seven of 41 post-RARP IH cases (95.1%) were indirect, but only 4 cases (4.8%) were combined IH. _x000D_

Conclusions

Weak stream and PPV were predictive of IH after RARP. Prophylactic surgery should be performed during RARP in patients at high risk for post-RARP IH._x000D_ _x000D_

Funding

None