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

作者：Marien Tracy; Taouli Bachir; Telegrafi Shpetim; Babb James S; Lepor Herbert^*

来源：BJU International, 2012, 110(11B): E601-E606.

DOI：10.1111/j.1464-410X.2012.11334.x

• prostate cancer
• prostatectomy
• inguinal hernia
• ultrasonography
• magnetic resonance imaging

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 significantly 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 significantly decreases the risk of developing post-prostatectomy clinical IHs.

• 出版日期2012-12