Anatomical Retzius-space preservation is associated with lower incidence of postoperative inguinal hernia development after robot-assisted radical prostatectomy

Chang, Kihun; Raheem, Ali Abdel; Santok, Glen Denmer; Kim, L. H. C.; Lum, Trenton G.; Lee, Seung Hwan; Ham, Won Sik; Choi, Young Deuk; Rha, Koon Ho

doi:10.1007/s10029-017-1588-9

Cited by 33 publications

(34 citation statements)

References 24 publications

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“…7,8,11e16 With regard to preoperative predictive factors low BMI was associated with an increased risk of postoperative IH in 3 of 11 studies. 12,14,17 This was statistically significant on univariate analysis in all 3 studies. Due to inconsistencies in BMI reporting it was difficult to determine a BMI cutoff which places a patient at increased IH risk but in general the risk correlated with a mean BMI of less than 25 kg/m 2 .…”

Section: Predictive Factorsmentioning

confidence: 74%

“…16 In the case of Retzius space preservation vs a conventional RALP approach the reduction in the IH incidence is more apparent, given that this approach is likely to spare vital myopectineal structures around the IIR. 17 In 2 of 11 studies the I-PSS scores were associated with an increased IH incidence after RARP. Majima et al observed a statistically significant correlation between de novo IH occurrence in men with a preoperative I-PSS question 6 score greater than 2.…”

Section: Predictive Factorsmentioning

confidence: 97%

“…In terms of operative factors the extraperitoneal approach 16 and nerve sparing 15 were associated with an increased risk of post-RALP IH while Retzius space sparing surgery was associated with lower IH occurrence. 17 It is unclear from the data why nerve sparing is associated with IH development as nerve preservation is unlikely to undermine the myopectineal structures surrounding the IIR. Findings in the retrospective study by Yoshimine et al may be accounted for by differences in operative time, surgeon experience and study group numbers in the transperitoneal and extraperitoneal groups.…”

Section: Predictive Factorsmentioning

confidence: 99%

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Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review

et al. 2019

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Inguinal hernia is a known sequel of radical prostatectomy which contributes to patient morbidity and health care expenditure. In this systematic review we evaluated the incidence of inguinal hernia associated with minimally invasive radical prostatectomy, in addition to predictive factors and preventive measures. Materials and Methods: We searched PubMedÒ and EmbaseÒ between 2000 and February 2018 using the search terms inguinal hernia and radical prostatectomy. Results: In concordance with search terms and selection criteria we identified a total of 155 reports with 27 studies eligible for inclusion. Collated results demonstrated a variable prevalence of inguinal hernia after laparoscopic radical prostatectomy and robotic assisted radical prostatectomy ranging from 4.3% to 8.3% and from 3% to 19.4 %, respectively. There was a higher mean prevalence of inguinal hernia after robotic assisted prostatectomy. Factors predicting inguinal hernia following minimally invasive radical prostatectomy included low body mass index, poor stream and straining prior to prostatectomy detected on symptom score instruments, a patent processus vaginalis or an intraoperative incidental inguinal hernia. Herniotomy or herniorrhaphy with onlay mesh repair was the most commonly reported intraoperative repair technique at the time of minimally invasive radical prostatectomy. Recurrence of repaired incidental hernia is rare. Conclusions: Inguinal hernia is common after minimally invasive radical prostatectomy. There is a lack of high level evidence to clarify risk factors and preventive strategies for inguinal hernia after minimally invasive radical prostatectomy. There is a justification for randomized controlled trials to further evaluate this under recognized clinical problem.

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Section: Predictive Factorsmentioning

confidence: 74%

Section: Predictive Factorsmentioning

confidence: 97%

Section: Predictive Factorsmentioning

confidence: 99%

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Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review

et al. 2019

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“…Chang et al found that Retzius space preservation with RARP lowered IH incidence compared with standard RARP. 27 They hypothesized that lower IH incidence might be due to the maximum preservation of anatomical structures of the anterior component including the space of Retzius, maintenance of the anatomical attachment of the entire bladder to the anterior abdominal wall fascia, and an undisturbed external prostate-vesicular angle. 28,29 In addition, the preservation of these anatomical structures may also preserve the myopectineal orifice and its components by avoiding medial stretching of the internal ring.…”

Section: Mechanism Of Ih Development After Rpmentioning

confidence: 99%

Inseparable interaction of the prostate and inguinal hernia

Miyajima

2018

Int J of Urology

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With an increase in their prevalence, it has become apparent that both benign prostatic hyperplasia and radical prostatectomy for cancer can induce inguinal hernia development. An inguinal hernia is a common late complication following radical prostatectomy, with an occurrence rate of 12-25%. Following radical prostatectomy, the space of Retzius can develop adhesions to surrounding tissue, often causing difficulty during inguinal hernia repair. Conversely, inguinal hernia repair before radical prostatectomy also induces severe adhesions around the space of Retzius and causes difficulty during radical prostatectomy. The association between radical prostatectomy and inguinal hernia development is complex and unclear. Both urologists and surgeons are challenged by this interaction. The surgical approaches for prostate cancer have undergone a major transition from open surgery to robotic surgery, and the treatment of inguinal hernia is also changing. Based on historical trends, several preventive and treatment measures have been proposed, although there is no direct evidence for risk factors that lead to inguinal hernia development. This article focuses on the complex interaction between the prostate and inguinal hernia, and considers preventive measures against inguinal hernia development.

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“…In addition to a higher early continence rate, RS‐RARP has a lower incidence of postoperative inguinal hernia occurrence compared with standard RARP . Theoretically, RS‐RARP may provide several other potential advantages.…”

Section: Summary Of Early Oncological Outcomes Of Retzius‐sparing Robmentioning

confidence: 99%

Reply: Retzius‐sparing robot‐assisted radical prostatectomy (RARP) vs standard RARP

Raheem

Rha

2018

BJU International

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Anatomical Retzius-space preservation is associated with lower incidence of postoperative inguinal hernia development after robot-assisted radical prostatectomy

Abstract: Our study showed that overall incidence of IH was 6.3% after RALP. Nevertheless, RS-RALP carries a lower incidence of IH after surgery, while C-RALP and low BMI are predictors of IH development.

Cited by 33 publications

References 24 publications

Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review

Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review

Inseparable interaction of the prostate and inguinal hernia

Reply: Retzius‐sparing robot‐assisted radical prostatectomy (RARP) vs standard RARP

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