Inguinal Hernia After Minimally Invasive Radical Prostatectomy
Posted: Tuesday, July 16, 2019
An inguinal hernia occurs about 3% to 19% of the time after minimally invasive radical prostatectomy, but there is little evidence about risk factors or preventive strategies, according to a recent review. The study was published in The Journal of Urology by Henry H. Woo, MD, of Chris O’Brien Lifehouse and the University of Sydney in Australia, and colleagues.
“Urologists should develop a systematic approach to detect and treat inguinal hernia, and patients should be counseled on the risk of post-minimally invasive radical prostatectomy inguinal hernia,” the authors wrote.
The review included 27 studies. According to these studies, the incidence of inguinal hernia was between 4.3% and 8.3% after laparoscopic radical prostatectomy and between 3% and 19.4% after robot-assisted radical prostatectomy. The average incidence was higher after robot-assisted prostatectomy than with the laparoscopic procedure.
Predictive factors in the studies included poor stream and straining before surgery, as detected via the International Prostate Symptom Score, or a patent processus vaginalis. Low body mass index (of roughly less than 25 kg/m2) was also predictive in three Korean studies, though it is not clear whether those results would generalize to other populations.
Low surgeon experience (fewer than 40 cases) was associated with a higher risk in robot-assisted radical prostatectomy. Surgical approach also affected the risk of inguinal hernia: an extraperitoneal approach and nerve sparing were associated with an increased risk, whereas Retzius space-sparing surgery was associated with a decreased risk.
The authors called for randomized controlled trials to find risk factors and preventive strategies for this condition. They believe that recommendations for urologists regarding how to identify and treat patients with inguinal hernias after minimally invasive radical prostatectomies would be helpful.
Disclosure: The study authors’ disclosure information may be found at auajournals.org.