Laparoscopic mesh herniorrhaphy: Impact on outcomes associated with radical retropubic prostatectomy

The impact of previous inguinal mesh hernioplasty on oncological and patient-reported outcomes following radical prostatectomy

BACKGROUND

The impact of previous inguinal mesh hernioplasty (MH) with non-resorbable mesh prostheses on surgical performance of radical prostatectomy (RP) has been controversially discussed, with unknown impact of MH on oncologic outcomes and health-related quality of life (HRQOL) following RP. We therefore aimed to assess the influence of previous MH on metastasis-free survival (MFS), biochemical recurrence-free survival (BRFS), and HRQOL following RP.

METHODS

We identified 344 patients with previous MH prior RP within our prospectively assessed institutional database of 6275 patients treated with RP for PC (2008-2019). A 1:3 propensity-score matched analysis of 1345 men (n = 319 previous MH, n = 1026 no previous MH) was conducted. Primary endpoint was MFS and secondary endpoints were BRFS and HRQOL (based on EORTC QLQ-C30). Binary logistic regression, Kaplan-Meier, and Cox regression models tested the effect of previous MH on MFS, BRFS, and HRQOL (p < 0.05).

RESULTS

Median follow-up was 47 months. Patients with previous MH had significantly lower 5-year MFS (72% vs. 85%, p < 0.001) and 5-year BRFS estimates (43% vs. 57%, p < 0.001). In multivariate analysis, previous MH was confirmed as an independent predictor for impaired MFS (hazard ratio [HR]: 3.772, 95% CI 1.12-12.64, p = 0.031) and BRFS (HR: 1.862, 95% CI: 1.22-2.85, p = 0.004). These results held true if stratified for surgical approach or limited to patients with successful PLND. We found significantly shorter median time to continence recovery for patients without previous MH (p = 0.001) without significant differences in total continence recovery rates, erectile function recovery, and HRQOL.

CONCLUSIONS

Our findings show an impaired oncologic outcome for patients with previous MH following RP with no significant differences regarding continence recovery, erectile function recovery, and general HRQOL.

Patent processus vaginalis in adults who underwent robot-assisted laparoscopic radical prostatectomy: predictive signs of postoperative inguinal hernia in the internal inguinal floor

OBJECTIVE

To evaluate the risk for postoperative inguinal hernia according to the presence of patent processus vaginalis in an adult population.

METHODS

Medical records of 205 patients who underwent robot-assisted laparoscopic radical prostatectomy from May 2007 to November 2011 were reviewed. Age, prostate-specific antigen, prostate volume, body mass index, operative time and history of previous abdominal surgery were evaluated. The existence of patent processus vaginalis was also evaluated for the development of postoperative inguinal hernia.

RESULTS

Postoperative inguinal hernia occurred in 20 out of 410 (4.9%) groins (17/205 patients; 8.3%), and patent processus vaginalis was observed in 49 out of 410 (11.9%) groins. In the normal groin group, inguinal hernia occurred in seven out of 361 (1.9%) groins. However, in the patent processus vaginalis group, it occurred in 13 out of 49 (26.5%) groins. On univariate analysis using Cox proportional hazards model, age, body mass index, history of previous abdominal surgery and patent processus vaginalis were significant risk factors. Among them, patent processus vaginalis significantly increased the risk of postoperative inguinal hernia in multivariate analysis (hazard ratio 22.37). In the patent processus vaginalis group, inguinal hernia developed at 12.9 ± 9.2 months after robot-assisted laparoscopic radical prostatectomy and 15 ± 7.4 months in the normal groin group. Inguinal hernia-free ratios were significantly lower in the patent processus vaginalis group than the normal groin group (P<0.001).

CONCLUSIONS

The existence of patent processus vaginalis represents an important risk factor for postoperative inguinal hernia in adults. Urologists should consider the possibility of postoperative inguinal hernia when patent processus vaginalis is observed during surgery.

Case-matched analysis of outcome after open retropubic radical prostatectomy in patients with previous preperitoneal inguinal hernia repair

Background

The impact of preperitoneal mesh repair for inguinal hernia on future pelvic surgery is debatable. This retrospective study investigated the impact of previous preperitoneal inguinal hernia repair (PIHR) on outcome after open retropubic radical prostatectomy (RRP) for prostatic cancer.

Methods

Patients who had open RRP and who had previously undergone PIHR were identified. They were compared with a control group of patients matched for age, body mass index and tumour risk profile who had no history of inguinal hernia repair. Outcome measures included intraoperative data, histopathology and results at follow-up.

Results

Sixty patients who had undergone open RRP after a previous PIHR were compared with 60 control patients. Operations lasted longer in the PIHR group (median (interquartile range, i.q.r.) 100 (90–120) versus 90 (85–100) min respectively; P &lt; 0·001) and the operation was assessed as more difficult by the surgeon (P = 0·022). Hospital stay was longer for patients who had undergone PIHR (median (i.q.r.) 7 (6–9) versus 6 (5–7) days; P = 0·012) and urinary catheterization was prolonged (13 (11–14) versus 11 (11–12) days; P = 0·006). Among patients with intermediate- and high-risk disease, fewer lymph nodes were excised in the PIHR group than in the control group (median (i.q.r.) 2 (0–7) versus 8 (5–12) nodes; P &lt; 0·001).

Conclusion

Open RRP for prostatic cancer was more difficult to perform after previous PIHR, and was associated with a longer hospital stay and less adequate lymphadenectomy for intermediate- and high-risk prostatic cancer.