Ricardo F Sánchez-Ortiz1, Carolina Andrade-Geigel2, Héctor López-Huertas2, Ronald Cadillo-Chávez2, Omar Soto-Avilés2. 1. Robotic Urology and Oncology Institute, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico. Electronic address: drsanchezortiz@gmail.com. 2. Robotic Urology and Oncology Institute, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Abstract
PURPOSE: Studies have shown that encountering an inguinal hernia during robotic radical prostatectomy is not uncommon. We reviewed our experience with simultaneous robotic prostatectomy and mesh hernia repair to identify variables predictive of a hernia. MATERIALS AND METHODS: Our cohort consisted of 693 consecutive men who underwent robotic radical prostatectomy as performed by 1 surgeon. Hernias were repaired with mesh composed of equal parts of absorbable polyglecaprone-25 and nonabsorbable polypropylene monofilament. Preoperative variables potentially predictive of an inguinal hernia were evaluated. RESULTS: Inguinal hernias were encountered in 55 of 639 patients (8.6%), of which 22.3% were bilateral for a total of 68 hernia sides. Only 26 of 55 hernias (47.2%) were evident preoperatively. Men with a preoperative I-PSS (International Prostate Symptom Score) of 15 or greater had a 22.4% chance (30 of 134) of requiring a hernia repair compared with 5% in those without such a score (OR 5.54, 95% CI 3.13-9.81, p <0.0001). There were no differences between the hernia and nonhernia groups in prostate size, body mass index, age, blood loss, transfusions, operative time, length of stay or any Clavien grade II-V complication. In 47 patients there was 1 recurrence at a median followup of 27.9 months. There were no cases of mesh associated pain or erosion. CONCLUSIONS: Independent of prostate size, men with preoperative lower urinary tract dysfunction were at 5 times the risk of a hernia at robotic radical prostatectomy (22.4% vs 5%). Given that half of the hernias were subclinical, patients with an I-PSS of 15 or greater should be counseled about the potential need for hernia repair at robotic radical prostatectomy.
PURPOSE: Studies have shown that encountering an inguinal hernia during robotic radical prostatectomy is not uncommon. We reviewed our experience with simultaneous robotic prostatectomy and mesh hernia repair to identify variables predictive of a hernia. MATERIALS AND METHODS: Our cohort consisted of 693 consecutive men who underwent robotic radical prostatectomy as performed by 1 surgeon. Hernias were repaired with mesh composed of equal parts of absorbable polyglecaprone-25 and nonabsorbable polypropylene monofilament. Preoperative variables potentially predictive of an inguinal hernia were evaluated. RESULTS: Inguinal hernias were encountered in 55 of 639 patients (8.6%), of which 22.3% were bilateral for a total of 68 hernia sides. Only 26 of 55 hernias (47.2%) were evident preoperatively. Men with a preoperative I-PSS (International Prostate Symptom Score) of 15 or greater had a 22.4% chance (30 of 134) of requiring a hernia repair compared with 5% in those without such a score (OR 5.54, 95% CI 3.13-9.81, p <0.0001). There were no differences between the hernia and nonhernia groups in prostate size, body mass index, age, blood loss, transfusions, operative time, length of stay or any Clavien grade II-V complication. In 47 patients there was 1 recurrence at a median followup of 27.9 months. There were no cases of mesh associated pain or erosion. CONCLUSIONS: Independent of prostate size, men with preoperative lower urinary tract dysfunction were at 5 times the risk of a hernia at robotic radical prostatectomy (22.4% vs 5%). Given that half of the hernias were subclinical, patients with an I-PSS of 15 or greater should be counseled about the potential need for hernia repair at robotic radical prostatectomy.