Analysis Of Risk Factors With Special Reference To Preoperative Inguinal Hernia Morbidity And Pelvic Lymph Node Dissection

UroToday.com - Inguinal hernia (IH) as a complication of radical retropubic prostatectomy (RRP) was first recognized in 1996 by Regan et al who reported a 12 percent incidence within 6 months of RRP. An incidence of 13.6 percent of IH post RRP and pelvic lymph node dissection was noted among 375 patients reported by J. Stranne and colleagues from Goteborg, Sweden in 2001. Recently, the same authors reported on the incidence of IH after RRP in nearly 700 patients and analyzed risk factors for this association. The study is published in the November 2006 issue of the Journal of Urology.

A total of 498 patients underwent RRP plus pelvic lymph node dissection (PLND) and 166 patients underwent RRP alone over a 4 year period. All patients undergoing their procedures between 2001 and 2003 (n = 271) patients were administered a questionnaire by mail at 3, 6, 12, 18, 24 and 36 months. A total of 207 patients (76.4%) completed and returned their questionnaires and comprised the study group. The impact of 5 potential risk factors were specifically analyzed; pre-operative IH morbidity, postoperative anastomotic stricture, patient age at RRP, the presence of a concurrent PLND, and surgical procedure duration. Mean follow-up was 40 months and mean age at RRP was 63 years.

Analysis of results showed a cumulative incidence of inguinal hernia after 24 months was 11.6% in the patient file survey and 15.7% in the patient administered questionnaire. Mean time to hernia occurrence was 16 months (median 11 months). Of the 498 patients who underwent simultaneous RRP and PLND, 66 (13%) had an IH post-operatively compared to 23 of the 166 (14%) who underwent RRP only. A total of 56 patients had undergone previous IH surgery of who 8 experienced an IH post-operatively including 4 on the previously operated side. Thus, the recurrence rate was 7.1% (4 of 56 cases). Only patient age was found to be an independent risk factor. PLND, previous IH morbidity, postoperative anastomotic stricture and surgery duration were not significant risk factors for an IH postoperatively.

This study removes some of the potential risk factors for the development of an IH post RRP from the list of possibilities. The authors believe that patient constitution and length of surgical incision may be possible risk factors and that careful attention to the presence of an IH preoperatively can aid the urologist in reducing the incidence of the IH after RRP. Concurrent surgical management of the two conditions seems advantageous.

Stranne J, Hugosson J, Lodding P
J Urol. 2006 Nov;176(5):2072-76

Reviewed by UroToday.com Contributing Editor Michael J. Metro, M.D

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