Impact of previous mesh hernia repair on the performance of open radical prostatectomy – complications and functional outcome

• Published in: BJU international 2010-12, Vol.106 (11), p.1628-1631
• Main Authors: Hocaoglu, Yasemin, Bastian, Patrick, Buchner, Alexander, Bauer, Ricarda, Bader, Markus, Tritschler, Stefan, Stanislaus, Peter, Stief, Christian, Karl, Alexander
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Body Mass Index; Feasibility Studies; Gynecology. Andrology. Obstetrics; Hernia, Inguinal - complications; Hernia, Inguinal - surgery; Humans; inguinal hernia repair; Lymph Node Excision; Male; Male genital diseases; Medical sciences; mesh; Middle Aged; Nephrology. Urinary tract diseases; Prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - complications; Prostatic Neoplasms - surgery; radical prostatectomy; Retrospective Studies; Surgical Mesh; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09495.x

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVES To determine the impact of previous inguinal mesh hernia repair (IMHR) on the performance of subsequent open radical retropubic prostatectomy (ORRP). PATIENTS AND METHODS A total of 1466 patients underwent ORRP for clinically localized prostate cancer from 2004 to 2008; 51 patients (3.5%) presented with a history of IMHR. Body‐mass index (BMI), perioperative blood loss (PBL), operating time (OT), performance of pelvic lymph node dissection (PLD), positive resection‐margins (R1), continence and potency between the groups were analysed using Mann–Whitney U and χ2 tests. RESULTS Fifty‐one patients with previous IMHR were compared with 1466 patients without previous mesh implantation (nMI) who underwent ORRP. Mean age was 66.8 years and mean BMI 25.7. No statistically difference in the mean OT (68 vs 72 min, P= 0.112), mean PBL (167 vs 156 ml, P= 0.089) or R1 was observed in the pT2‐stage tumors (3% vs 9.7%, P= 0.197), or in the pT3‐stage tumors (16% vs 21%, P= 0.386). After 3 months 85% showed full continence in the nMI group vs 83.9% MI group (P= 0.864) and after 12 months 94.5% of the nMI patients vs 97.6% with mesh (P= 0.610). The IIEF‐5 score after 3 months showed a median of 9.0 in the MI group and 4.5 in the nMI group (P= 0.116) and after 12 months 12.0 in the MI group and 9.0 in the nMI group (P= 0.511). PLD was significantly more feasible in patients that underwent only unilateral IMHR compared with bilateral IMHR (96% vs 40%, P= 0.001) and significantly less feasible if previous IMHR was operated laparoscopically than with an open access (47% vs 88%, P= 0.014). CONCLUSION No impairment of perioperative variables or functional outcome during ORRP was observed in patients with IMHR. PLD could be performed in a significantly fewer patients who underwent bilateral IMHR or laparoscopic IMHR.