Optimizing the detection of subclinical inguinal hernias in men undergoing open radical retropubic prostatectomy

Marien, Tracy; Taouli, Bachir; Telegrafi, Shpetim; Babb, James S.; Lepor, Herbert

doi:10.1111/j.1464-410x.2010.09434.x

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…Even the patients without subjective symptoms had suspected IH on imaging and intraoperative findings [18,22] . In RARP cases, Lee et al [13] showed that lesser number of people, 7 groins out of 361 (1.9%) normal groins, developed IH.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Shimbo

Endo²,

Matsushita³

et al. 2016

Urol Int

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Introduction: To evaluate the incidence and risk factors for postoperative inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) and to assess whether a newly developed prevention technique reduces the incidence of IH after RARP. Methods: We included 161 consecutive patients (322 groins) who underwent RARP between September 2011 and October 2013. The prevention technique was as follows: (1) sufficient incision of peritoneum around the internal inguinal ring; (2) separation of spermatic vessels; (3) dissection of vas deferens. Results: Postoperative IH occurred in 14 cases (19.4%) occurring in the observation group compared to 2 cases (2.2%) in the prevention group. Patent processus vaginalis (PPV) was the only risk factor. Time-to-event analysis demonstrated a significant decrease in IH incidence in the IH prevention group (p = 0.005). Conclusion: Our data reveal a higher incidence of IH after RARP, with the existence of PPV as the only identified risk factor. Our simple IH-prevention technique, which does not involve the use of artificial materials, appears safe and effective.

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Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Shimbo

Endo²,

Matsushita³

et al. 2016

Urol Int

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“…Preoperative screening for subclinical hernia and subsequent repair at prostatectomy have been suggested, 26,27 and some surgeons do in fact perform hernia repair or sutures to prevent hernia at the time of the prostatectomy. 28 However, it is unlikely that all subclinical hernias should be repaired, 29,30 because 6% of men undergoing groin hernia repair have pain that interferes with everyday life activity after surgery, 31 and far from all hernias are symptomatic.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Groin Hernia Repair After Radical Prostatectomy

et al. 2014

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An almost 4-fold increase in groin hernia repair was observed after radical prostatectomy compared with controls, and men who received radiation therapy had an almost 2-fold increase in incidence. As well as postoperative changes in the abdominal wall, increased vigilance for groin hernia seems to be important for the increased incidence of groin hernia repair seen after radical prostatectomy or radiation therapy for prostate cancer.

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“…We have shown that subclinical IHs can be detected using US or MRI if special protocols are used [13]. One disadvantage of MRI is that it is performed in the supine position, which is not optimal for detecting IHs.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography of the bilateral inguinal canals was carried out as the patient was performing a Valsalva manoeuvre while in the upstanding position and was interpreted by a single experienced radiologist using a Sequoia ultrasound machine and a 10‐MHz linear transducer. An MRI of the inguinal canals was performed in the supine position at rest and during a Valsalva manoeuvre during a prostate MRI examination as previously described [13]. In less than 5% of cases the prostate MRI was performed at another institution without Valsalva.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post‐prostatectomy hernia

et al. 2012

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What ' s known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias.To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to < 1%. OBJECTIVE• To assess if a comprehensive evaluation to diagnose clinical and subclinical hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. PATIENTS AND METHODS• Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon.• Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging.• Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. RESULTS• Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality.• Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs.• No preoperative factor was signifi cantly associated with the presence of an IH before prostatectomy.• No groin subjected to IH repair (IHR) at the time of ORRP developed a clinical IH compared with four of the 21 patients with postoperative IHs who did not undergo repair of their preoperatively diagnosed IH at the time of ORRP ( P = 0.024).• Only one (0.4%) clinical IH developed in a groin that had no evidence of IH by physical examination, upstanding ultrasonography and magnetic resonance imaging before prostatectomy. CONCLUSIONS• Our comprehensive evaluation increases the detection of IHs before ORRP.• Repair of these IHs at the time of ORRP signifi cantly decreases the risk of developing post-prostatectomy clinical IHs. KEYWORDSprostate cancer , prostatectomy , inguinal hernia , ultrasonography , magnetic resonance imaging Study Type -Therapy (case series) Level of Evidence 4

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Optimizing the detection of subclinical inguinal hernias in men undergoing open radical retropubic prostatectomy

Cited by 13 publications

References 18 publications

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Incidence, Risk Factors and a Novel Prevention Technique for Inguinal Hernia after Robot-Assisted Radical Prostatectomy

Incidence of Groin Hernia Repair After Radical Prostatectomy

Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post‐prostatectomy hernia

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