Login to Access Video or Poster Abstract: MP97-06
Sources of Funding: none

Introduction

The number of patients (pts.) undergoing radical prostatectomy has increased due to early detection of prostate cancer. The two most frequently occurring and well descrbed complications of radical prostatectomy are incontinence and impotence. Inguinal hernia (IH) has emerged as an additional complication with an estimated incidence of 15-20% after radical retropubic prostatectomy (RRP), 7,4% after laparoscopic prostatectomy and 5,8% after robotic prostatectomy. The internal inguinal ring is composed of transversalis fascia and suspended by the transversus abdomen muscle, so that injury to these structures or their nerve supply during surgery could be associated with the development of an indirect IH. The objective of the study is to assess the incidence and the risk factors for an IH development in a series of pts. undergone RRP._x000D_ _x000D_ _x000D_

Methods

360 pts. age ranged from 51 to 73 years, underwent RRP by a single surgeon. During the follow up many pts. complained the development of an IH not detected before surgery. This finding stimulated the Authors to screen all pts. for a post surgical IH by means of physical examination, upstanding ultrasonography and a questionnaire designed to capture the development of clinical IH. 86 pts. responded or were evaluable for the study. The potential risk factors for IH like a previous hernia, increasing age, BMI, bladder neck contracture,intraoperative profuse bleeding > 1000 ml., diabetes or infection of the surgical wound, were evaluated.

Results

15 pts. (17,4%) developed a postoperative IH from 6 months to two years after RRP. 27 pts.(31,4%) underwent IH repair before RRP and of these,7 pts.(8,1%)developed a contralateral postoperative IH. Important risk factors for the development of post-RRP IH were a low BMI <25KG/m2 (40%)and diabetes (27%)in pts. with increasing age (mean 64,2 yrs.) while the other risk factors considered were not significantly associated with the postoperative IH risk.

Conclusions

A higher incidence of IH is noted in the post radical prostatectomy population compared with the general adult male population, suggesting that the procedure has an increased risk of IH formation. The incision of the transversalis fascia, a component of the internal inguinal ring, is the surgical step that rise the risk for an hernia formation. Old pts. with a low BMI and diabetes are particularly prone to increased morbidity from IH. Urologists should consider this finding when counseling pts. for complications, and a prophylactic surgery for high risk subjects should be considered at the time of radical prostatectomy to decrease the risk of postoperative IH formation.

Funding

none