Inguinal hernia after a radical prostatectomy for localized prostate cancer

Since prostate-specific antigen (PSA) screening began in the 1980s in Taiwan, there has been a significant increase in the detection of prostate cancers (PCs) at an earlier stage. For clinically localized PC, a radical prostatectomy (RP) remains the gold standard treatment. However, patients undergoing a RP for PC are at risk of onset or worsening of inguinal hernias (IHs). We reviewed the current status of IHs after a RP. We reviewed literature published from PubMed using the key words of “inguinal hernia”, “prostatectomy”, and “prostate cancer”. The postprostatectomy mechanism was illustrated. The incidences of various prostatectomies were recorded. The prediction and prevention of postprostatectomy IHs were analyzed. Disruption of the transversalis fascia caused by surgical procedures was proposed as contributing to postprostatectomy-related IH formation because it assaults the anatomic-physiological balance in the abdominal wall. The myopectineal orifice is traversed by the spermatic cord and femoral vessels, and its inner surface is sealed by the transversalis fascia. A body mass index of <23 kg/m2 and a history of previous IH repair were significant risk factors for postoperative IH. The incidence of IHs after surgery was reported to range from 12.4% to 23.9%, and most IHs occur within 6–24 months postprostatectomy. The incidence of IHs is greater with the extraperitoneal approach than with the transperitoneal approach. A preoperative abdominal computed tomography (CT)-scan might identify asymptomatic IHs, but the test lacks sensitivity and is inferior to a simple physical examination (PE). A PE of the groin should be performed before a RP, and careful surgical manipulation is essential to prevent postoperative IHs. The concurrent repair of any detectable IHs at the time of a prostatectomy could significantly reduce the incidence of postoperative IHs.