Laparoscopic Inguinal Herniorrhaphy Complicating Radical Cystoprostatectomy

Abstract

This report describes 2 patients who underwent cystoprostatectomy for bladder cancer after bilateral laparoscopic inguinal herniorrhaphy by using a sheet of mesh that obliterated the space of Retzius. Two men who had undergone bilateral laparoscopic herniorrhaphy with a sheet of polypropylene mesh presented with muscle-invasive bladder cancer. Their operative findings are presented. Despite reports suggesting that prostatectomy and, by implication, cystectomy could not be safely performed in this setting, both men underwent surgical exploration because of the lack of adequate potentially curative alternatives. Nerve sparing was possible in one man, leading to recovery of erections after surgery. Extended lymphadenectomy was possible in one man but was not completed in the other because of scarring throughout the pelvis that precluded safe removal of traditional node templates. Unlike prostate cancer, which is amenable to nonextirpative therapeutic options, bladder cancer is most definitively treated with removal of the bladder and prostate. Despite reports that prostatectomy could be impossible in this setting, we found that cystoprostatectomy was substantially more difficult but could be performed in this setting.