MP47-18 CONTRIBUTORS TO THE OCCURRENCE OF INGUINAL HERNIA AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY.

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV1 Apr 2017MP47-18 CONTRIBUTORS TO THE OCCURRENCE OF INGUINAL HERNIA AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY. Tsuyoshi Majima, Yasushi Yoshino, Yoshihisa Matsukawa, Yasuhito Funahashi, Naoto Sassa, Masashi Kato, Tokunori Yamamoto, and Momokazu Gotoh Tsuyoshi MajimaTsuyoshi Majima More articles by this author , Yasushi YoshinoYasushi Yoshino More articles by this author , Yoshihisa MatsukawaYoshihisa Matsukawa More articles by this author , Yasuhito FunahashiYasuhito Funahashi More articles by this author , Naoto SassaNaoto Sassa More articles by this author , Masashi KatoMasashi Kato More articles by this author , Tokunori YamamotoTokunori Yamamoto More articles by this author , and Momokazu GotohMomokazu Gotoh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies reported that about 10% of patients who underwent retropubic radical prostatectomy developed inguinal hernia (IH) after surgery. However, few studies have evaluated IH following robot-assisted radical prostatectomy (RARP). We retrospectively investigated the incidence and risk factors for IH after RARP. METHODS Subjects included patients who underwent RARP for prostate cancer in our institution from February 2012 to January 2015. Those with previous/concomitant IH history, concurrent IH-prophylaxis surgery, and follow-up < 1 year were excluded. Demographic and clinical profiles were collected from medical records. Every RARP video record was reviewed by a blinded urologist to verify the existence of a patent processus vaginalis (PPV). Univariate and multivariate Cox proportional hazards models were used to determine relationships between post-RARP IH and age, body mass index (BMI), previous lower abdominal surgery, total International Prostate Symptom Score (IPSS), IPSS voiding score, IPSS storage score, IPSS question 5 (weak stream) and 6 (straining) score, maximum urethral closing pressure (MUCP) and functional profile length (FPL) on urethral pressure profile, prostate weight, and PPV. Pre- and postoperative IPSS, MUCP, and FPL were included. RESULTS Of 284 patients in the study, 41 (14.4%) developed IH at a median 8 months after RARP. On univariate analysis, BMI ≥ 23, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.24 - 0.89, p = 0.02; HR 2.20, 95% CI 1.12 - 4.3, p = 0.02; HR 3.59, 95% CI 2.39 - 5.40, p < 0.001, respectively). On multivariate analysis, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (HR 2.77, 95% CI 1.40 - 5.51, p = 0.003; HR 3.87, 95% CI 2.46 - 6.07, p < 0.001). PPV was detected on the right (51 patients, 17.9%), left (23, 8.0%), and both (15, 5.2%) sides. Twenty-three of 51 patients (45.0%) with right-side PPV, 5 of 23 (26.0%) with left-side PPV, and 5 of 15 (33.3%) with bilateral PPV developed IH after RARP. Thirty-seven of 41 post-RARP IH cases (95.1%) were indirect, but only 4 cases (4.8%) were combined IH. CONCLUSIONS Weak stream and PPV were predictive of IH after RARP. Prophylactic surgery should be performed during RARP in patients at high risk for post-RARP IH. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e635 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tsuyoshi Majima More articles by this author Yasushi Yoshino More articles by this author Yoshihisa Matsukawa More articles by this author Yasuhito Funahashi More articles by this author Naoto Sassa More articles by this author Masashi Kato More articles by this author Tokunori Yamamoto More articles by this author Momokazu Gotoh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...