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Published on: May 19, 2022
Inguinal hernia after radical perineal prostatectomy: comparison with the retropubic approach
Akio Matsubara1, Tatsuaki Yoneda, Takahisa Nakamoto
1Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. matsua@hiroshima-u.ac.jp
Objectives:
To clarify the characteristics of inguinal hernia (IH) after radical perineal prostatectomy (RPP) compared with that after radical retropubic prostatectomy (RRP).
Methods:
We retrospectively reviewed 285 and 311 men who underwent RPP and RRP, respectively, for clinically localized prostate cancer between August 2000 and June 2006, using medical records and a telephone survey.
Results:
The incidence of postoperative IH after RPP was 1.8% (5 of 285) with a median follow-up time of 43 months; that after RRP was 10.3% (32 of 311) with a median follow-up of 36 months (P <0.0001). The cumulative IH-free rate was significantly higher after RPP than after RRP (P <0.0001, log-rank test). Three of the five RPP patients (60%) developed IH more than 24 months after surgery, whereas 25 of 32 (78%) of the RRP group did so within 24 months (P = 0.0742). The incidence rate of post-RPP IH did not differ between the standard (4 of 194 = 2.1%) and modified (1 of 91 = 1.1%) RPP procedures, where the endopelvic fascia was left intact and opened, respectively (P = 0.5638).
Conclusions:
The incidence of IH after RPP appears to be sporadic and about the same as that (2.0-2.4%) reported previously in men with prostate cancer treated nonsurgically. Although some kinds of procedures during RRP are speculated to affect the internal inguinal ring, prostatectomy with or without opening of the endopelvic fascia seems to be less implicated in the development of IH after RRP because it was not a significant variable in IH development after different techniques had been used in RPP.
Insights
Radical perineal prostatectomy (RPP) shows a significantly lower incidence of inguinal hernia (IH) compared to radical retropubic prostatectomy (RRP). Post-RPP IH rates are comparable to non-surgical cancer treatment, suggesting RPP may be a safer surgical option.
Area of Science:
- Urology
- Surgical Oncology
- Gastroenterology
Background:
- Inguinal hernia (IH) is a potential complication following prostatectomy.
- Comparing IH rates between different prostatectomy approaches is crucial for patient outcomes.
Purpose of the Study:
- To compare the incidence and characteristics of inguinal hernias (IH) after radical perineal prostatectomy (RPP) versus radical retropubic prostatectomy (RRP).
Main Methods:
- Retrospective review of 285 RPP and 311 RRP patients for prostate cancer.
- Data collected via medical records and telephone surveys between August 2000 and June 2006.
Main Results:
- Lower IH incidence after RPP (1.8%) compared to RRP (10.3%) (P <0.0001).
- Significantly higher cumulative IH-free rate after RPP (P <0.0001).
- No significant difference in post-RPP IH rates based on endopelvic fascia management (P = 0.5638).
Conclusions:
- Inguinal hernia incidence after RPP is low and comparable to non-surgical prostate cancer treatment.
- Prostatectomy technique, including endopelvic fascia management, appears less implicated in IH development after RRP.