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Updated: Aug 24, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Concurrent radical retropubic prostatectomy and inguinal hernia repair through a modified Pfannenstiel incision
M Manoharan1, P Gomez, M S Soloway
1Department of Urology, University of Miami School of Medicine, Miami, FL, USA.
Objective:
To describe a technique for concurrent radical retropubic prostatectomy (RRP) and inguinal hernioplasty, using a modified Pfannenstiel incision.
Patients And Methods:
RRP is usually done through a midline lower abdominal incision but some patients with localized prostate cancer have an inguinal hernia. Concurrent inguinal hernia repair at the time of RRP with the usual method is only possible by either a preperitoneal mesh repair or formal hernioplasty, requiring an additional incision(s). A 10-12 cm Pfannenstiel incision is made along the pubic hairline centred over the pubic symphysis, and a 'Y'-shaped incision in the rectus sheath. The rectus muscle is split vertically along the midline, followed by RRP. After removing the prostate and completing the anastomosis, the surgeon identifies the inguinal canal along the inferior and lateral aspect of the transverse incision and uses a formal tension-free hernioplasty with a 3 x 5 cm polypropylene mesh. We used this technique in fifteen concurrent inguinal hernioplasties (two bilateral hernias and thirteen unilateral) at the time of RRP, with no additional incisions, using the formal tension-free Lichtenstein technique. One patient with bilateral hernias had a right indirect inguinal hernia, and all the remaining men had a direct inguinal hernia.
Results:
All patients were discharged 2 days after surgery, with no complications associated with the procedure and no recurrences; however, the follow-up was short (mean 5.5 months).
Conclusion:
A modified Pfannenstiel incision is ideal for concurrent RRP and inguinal hernioplasty, providing excellent exposure of the pelvic structures and allowing the surgeon to use a formal tension-free mesh hernioplasty through the same incision. Wound healing and cosmetic results are excellent.
Insights
This study presents a modified Pfannenstiel incision technique for combining radical retropubic prostatectomy (RRP) and inguinal hernioplasty. The novel approach allows for concurrent repair without additional incisions, demonstrating excellent outcomes.
Area of Science:
- Urology
- Surgical Oncology
- Hernia Surgery
Background:
- Radical retropubic prostatectomy (RRP) typically requires a midline incision.
- Patients undergoing RRP may also have inguinal hernias, necessitating concurrent repair.
- Standard concurrent repair often requires additional incisions, increasing patient morbidity.
Purpose of the Study:
- To describe a modified Pfannenstiel incision technique for simultaneous RRP and inguinal hernioplasty.
- To evaluate the feasibility and outcomes of this combined surgical approach.
- To assess the benefits of avoiding additional incisions for hernia repair.
Main Methods:
- A modified 10-12 cm Pfannenstiel incision was utilized, centered over the pubic symphysis.
- A 'Y'-shaped incision in the rectus sheath allowed for vertical splitting of the rectus muscle for RRP.
- Following RRP, inguinal hernioplasty using a tension-free Lichtenstein technique with polypropylene mesh was performed through the same incision.
Main Results:
- Fifteen patients underwent concurrent RRP and inguinal hernioplasty using the described technique.
- All patients were discharged within 2 days postoperative with no complications or recurrences observed.
- Mean follow-up was 5.5 months, with excellent wound healing and cosmetic results reported.
Conclusions:
- The modified Pfannenstiel incision is an effective approach for concurrent RRP and inguinal hernioplasty.
- This technique provides excellent pelvic exposure and facilitates tension-free mesh hernioplasty via a single incision.
- The method offers superior cosmetic results and efficient surgical management.