The Incidence and Risk Factors for Inguinal Hernia after Radical Retropubic Prostatectomy

Sung Han Kim; Hwang Gyun Jeon; In Gab Jeong; Eunsik Lee

doi:10.4111/kju.2008.49.11.981

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Kim, Jeon, Jeong, and Lee: The Incidence and Risk Factors for Inguinal Hernia after Radical Retropubic Prostatectomy

Original Article

Korean J Urol 2008;49(11):981-985.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.11.981

The Incidence and Risk Factors for Inguinal Hernia after Radical Retropubic Prostatectomy

Sung Han Kim, Hwang Gyun Jeon, In Gab Jeong, Eunsik Lee

From the Department of Urology, Seoul National University College of Medicine, Seoul, Korea

Received 30 June 2008 Revised 14 July 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy (RRP).

Materials and Methods

We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model.

Results

The mean age of the patients was 64.6 years (range, 40 to 83). 32 (8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8 (25.8%) of 32 patients developed an inguinal hernia within 6 months, 23 (61.8%) within 1 year, 26 (83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25 (78.1%) developed an inguinal hernia in the right side, 3 (9.4%) in left and 4 (12.5%) developed an inguinal hernia in both sides. The operative time (p＜0.001), prostate volume (p=0.001), the presence of transfusion (p=0.001) and pelvic lymph node dissection (p=0.007) were significantly different between the patients with and without inguinal hernia. Multivariate analysis showed that the operative time (p=0.039), pelvic lymph node dissection (p=0.002), the presence of transfusion (p=0.012) and the prostate volume (＞50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia.

Conclusions

The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia.

Keywords: Radical retropubic prostatectomy, Inguinal hernia, Incidence rate, Risk factors

References

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Table 1.

The clinical patient's characteristics

Patient characteristics	Hernia group (n=32)	Non-hernia group (n=351)	p-value
Age (years) (Mean±SD)	64.2±7.5	64.7±6.9	0.716
BMI (kg/m²) (Mean±SD)	23.8±2.5	24.1±3.4	0.574
PSA (ng/ml) (Mean±SD)	12.3±1.5	14.8±1.0	0.439
No. TRUS volume (%)			0.001^∗
＜30cc	7 (21.9)	75 (22.1)	0.247
30–40cc	3 (9.3)	109 (32.1)
40–50cc	6 (18.8)	86 (25.3)
＞50cc	16 (50.0)	70 (20.5)
No. neoadjuvant hormonal treatment (%)	3 (9.3)	15 (4.6)
No. previous abdominal surgery (%)	3 (1)	24 (4)	0.228
Mean operative time (min)±SD	222.0±43.4	144.3±47.0	＜0.001^∗
No. transfusion (%)	20 (62.5)	113 (32.3)	0.001^∗
No. anesthesia type (%)
General	18 (56.3)	154 (44.0)	0.182
Others	14 (43.7)	196 (56.0)
No. nerve sparing (%)
Yes	18 (56.3)	154 (45.2)	0.878
No	14 (43.7)	187 (54.8)	0.878
No. pelvic LN dissection (%)	14 (43.7)	78 (22.3)	0.007^∗
No. incision type (%)
Low midline	27 (87.1)	300 (78.5)	0.982
Pfannestiel	4 (12.9)	45 (21.5)
Mean hospital stay (days)±SD	10.0±5.0	7.9±4.4	0.011^∗
No. post-RRP urethral stricture (%)	3 (9.3)	23 (6.6)	0.547
No biochemical recurrence (%)	29 (93.5)	310 (88.6)	0.725
No. resection margin positive (%)	10 (31.3)	128 (36.6)	0.592
No. organ confined (%)	19 (61.3)	205 (59.9)	0.883

^∗ : statistically significant factor, p＜0.05. BMI: body mass index, PSA: prostate-specific antigen, TRUS: transrectal ultrasonography, LN: lymph node, RRP: radical retropubic prostatectomy

Table 2.

Type and laterality of inguinal hernia after radical prostatectomy (n=32)

	No. of patient (%)
Type
Indirect	3 (9.3)
Direct	20 (62.5)
Unknown	9 (28.2)
Laterality
Right	25 (78.1)
Left	3 (9.3)
Bilateral	4 (12.6)

Table 3.

Multivariate analysis for predicting inguinal hernia after radical prostatectomy

Variables	Hazard ratio (95% CI)	p-value
Operative time (minutes)	1.01 (1.00–1.01)	0.039
Transfusion	2.80 (1.25–6.24)	0.012
Prostate volume (cc)		0.012
＜30	Reference
30–40	0.38 (0.10–1.49)	0.166
40–50	0.76 (0.24–2.40)	0.634
＞50	2.40 (0.98–5.88)	0.046
Lymph node dissection	3.37 (0.11–0.57)	0.002

CI: confidence interval

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