Inguinal hernia after radical retropubic prostatectomy for prostate cancer: A study of incidence and risk factors in comparison to no operation and lymphadenectomy

Purpose: The incidence, mechanisms and risk factors of inguinal hernia afte r radical retropubic prostatectomy are sparsely elucidated in the literatur e. We determined the rate of inguinal hernia after radical retropubic prost atectomy and compared it to the incidence in patients with prostate cancer who did not undergo operation or underwent only pelvic lymph node dissectio n. Materials and Methods: We followed 375, 184 and 65 men who underwent radica l retropubic prostatectomy plus pelvic lymph node dissection, pelvic lymph node dissection only and no surgery with respect to inguinal hernia for a m ean of 39, 47 and 45 months, respectively. The prostatectomy group was also evaluated in regard to the potential risk factors of previous hernia surge ry and post-prostatectomy anastomotic stricture. Results: The incidence of hernia was 13.6%, 7.6% and 3.1% in the prostatect omy, lymph node dissection and unoperated group, respectively. The differen ce was statistically significant in the prostatectomy and unoperated groups according to the Mantel-Cox log rank test and Cox proportional hazards rat e. Previous hernial surgery and post-prostatectomy anastomotic stricture we re more common in patients with an inguinal hernia after prostatectomy. Conclusions: The incidence of inguinal hernia is clearly increased in men w ho have undergone radical retropubic prostatectomy plus pelvic lymph node d issection compared with those who undergo no surgery for prostate cancer. I nguinal hernia appears to develop more often in men with prostate cancer wh o undergo radical retropubic prostatectomy and pelvic lymph node dissection than in those who undergo pelvic lymph node dissection only. While surgica l factors trigger hernial development, previous hernial surgery and post-pr ostatectomy anastomotic stricture may be important risk factors. In fact, t he latter may largely explain the difference in the incidence of inguinal h ernia in our lymph node dissection and prostatectomy groups. Prophylactic s urgical procedures must be evaluated to address this problem.