Inguinal hernia after open radical retropubic prostatectomy

A review article published on-line in Nature Reviews Urology has suggested that over the past decade some 15 to 20 percent of men undergoing open radical retropublic prostatectomy (RRP) as first-line treatment for prostate cancer have an inguinal hernia as a complication of their treatment. This is a significant risk factor, and appears to be limited to the open surgical procedure. The treatment of localized prostate cancer with other forms of surgical procedure (open radical perineal prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostectomy) appears to be associated with a far lower level of risk for inguinal hernia.

An inguinal hernia occurs when some of the contents of the abdominal cavity protrude through the inguinal canal. This type of hernia is very common in men as they get older, and rather more than 25 percent of men will have an inguinal hernia during their lifetime.

Stranne and Lodding have reviewed available data on the association between radical prostatatectomy and inguinal hernia, and make the following points:

  • Inguinal hernia has emerged as complication of radical prostatectomy over the past decade.
  • The estimated incidence of inguinal hernia after radical prostatectomy is 15-20 percent.
  • Inguinal hernia is common in men aged between 50 and 70 years with or without prostate cancer.
  • Important risk factors for the development inguinal hernia after open RRP are previous surgery for inguinal hernia, increasing age, and low body mass index.
  • Subclinical inguinal hernia at the time of RRP and a lower midline incision seem to be the most important causative factors for inguinal hernia post-RRP.

The authors recommend that prophylactic procedures and oncurrent repair of clinically detectable inguinal hernia lesions during RRP be taken to address the risk of inguinal hernia. They further advocate that risk for development of inguinal hernia after prostatectomy should be part of the preoperative risk assessment when making treatment decisions for patients with prostate cancer.

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