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Updated: Aug 14, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Systematic detection and repair of subclinical inguinal hernias at radical retropubic prostatectomy
Matthew E Nielsen1, Patrick C Walsh
1James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-2101, USA. nielsen@jhmi.edu
Objectives:
Inguinal hernias occur in 15% of men within 1 to 2 years after radical retropubic prostatectomy (RRP). This suggests that many of these hernias may have been present at surgery, but not diagnosed. Beginning in September 2001, all patients undergoing RRP were carefully examined intraoperatively for the presence of a hernia or a dilated internal inguinal ring. In this study we define the frequency of inguinal hernias detected at RRP and the durability of repair.
Methods:
Between September 2001 and December 2004, 430 patients underwent RRP by one surgeon. Hernias, detected in 142 men (33%), were repaired preperitoneally: direct hernias were repaired with mesh and indirect hernias with 2-0 Prolene suture. The patients were followed up for an average of 19 months (range 9 to 36). Information on postoperative hernia status was available for 315 men (73.3%).
Results:
Of the 430 patients, 142 (33%) had hernias repaired at RRP. Of these hernias, 32% were right sided, 28% left sided, and 40% bilateral; 34% were direct hernias and 66% indirect. Of the 142 patients who underwent intraoperative hernia repair, 95 (67%) had follow-up data, and 5 (5.3%) of that group developed a hernia postoperatively. None of the hernias repaired at RRP recurred. Recurrent hernias on the side of the repair occurred in 3.1%.
Conclusions:
Incidental inguinal hernias were commonly found (33%) at RRP. Two thirds of the defects detected were indirect. Clinical recurrence after repair was rare.
Insights
Inguinal hernias are common during radical retropubic prostatectomy (RRP), with 33% detected and repaired. Postoperative recurrence of these incidental hernias is rare, indicating durable repair.
Area of Science:
- Urology
- Surgical Oncology
- Hernia Surgery
Background:
- Inguinal hernias are a known complication after radical retropubic prostatectomy (RRP), with reported incidence rates of 15% within two years.
- The high incidence suggests many hernias may be occult or undiagnosed prior to RRP.
- Intraoperative detection and repair of incidental inguinal hernias during RRP have not been extensively studied.
Purpose of the Study:
- To determine the frequency of incidental inguinal hernias detected during RRP.
- To evaluate the durability and recurrence rates of repairs performed concurrently with RRP.
Main Methods:
- A prospective study of 430 patients undergoing RRP by a single surgeon between September 2001 and December 2004.
- Intraoperative examination for inguinal hernias or dilated internal inguinal rings.
- Repair of detected hernias using mesh for direct and Prolene suture for indirect types.
- Follow-up assessment of postoperative hernia status for 315 patients (73.3%) over an average of 19 months.
Main Results:
- Incidental inguinal hernias were detected in 142 out of 430 patients (33%).
- The majority of detected hernias were indirect (66%), with 40% being bilateral.
- Among 95 patients with follow-up data after repair, only 5.3% developed a postoperative hernia. No repaired incidental hernias recurred; overall recurrence on the side of repair was 3.1%.
Conclusions:
- A significant proportion of patients undergoing RRP have undiagnosed inguinal hernias.
- Intraoperative detection and repair of these incidental hernias are feasible and associated with low recurrence rates.
- Concurrent hernia repair during RRP appears to be a durable and effective strategy.