Impact of retraction of vas deferens in postradical prostatectomy inguinal hernia

The incidence of inguinal hernia after radical retropubic prostatectomy (RRP) is high. We speculated that retraction of the vasa deferentia with a retractor might cause stretch injury of the myopectineal orifice and lead to inguinal hernia. In testing this hypothesis, we performed RRP with a modified technique and followed up patients prospectively.

From 1993 to 2002, 171 patients underwent RRP with a retrograde approach, in which the vasa deferentia were cut after the prostate and seminal vesicles were finally exposed. From 2003 to 2005, 150 patients were followed up prospectively who had undergone RRP with a modified technique, in which the bilateral vasa deferentia and surrounding tissues were dissected before placing a retractor so as not to retract them and injure the myopectineal orifice. The incidence rates of inguinal hernia in the two groups were compared. In addition, for the entire group of 321 patients, we determined the risk factors for inguinal hernia after RRP using multivariate analysis.

Of the 150 patients in the modified method group, 22 (14.7%) developed an inguinal hernia during follow-up, and 42 (24.6%) of the 171 patients did so in the previous method group. No significant difference was noted between the two groups in terms of the hernia-free rate. Multivariate analysis revealed a body mass index of less than 23 kg/m2 and a history of previous inguinal hernia repair were significant risk factors for postoperative inguinal hernia.

We found that retraction of the vasa deferentia with a retractor did not affect the high incidence of postoperative inguinal hernia after RRP.