Evaluation of simultaneous open prostatectomy and preperitoneal inguinal herniorrhaphy with polypropylene mesh application with single incision

Background: Benign prostatic hyperplasia [BPH] is one of the common problems in older men which in many cases need to be treated. However, the incidence of inguinal hernia increases with age and a significant number of patients with symptoms of BPH, have concurrent inguinal hernia. Although simultaneous suprapubic prostatectomy and inguinal herniorrhaphy is one of the treatment options, but routinely it is not used. This study was aimed to evaluate the results of this surgical procedure

Methods: In this study. 122 patients who were underwent open suprapubic prostatectomy and simultaneous preperitoneal herniorrhaphy with polypropylene mesh application, were evaluated and outcomes and complications of this procedure was recorded

Results: Of 122 patients were enrolled, 38 [31.1%] patients had bilateral inguinal hernia, of 170 hernias, 29 were direct inguinal hernia and 141 were indirect, of 84 patients with unilateral hernia 33 patients had inguinal hernia on the left side and 51 patients on the right side. The median clinical follow-up time was 26.4 months [range 1248 months]. During the follow-up period, surgical site infection, hematoma, chronic pain and hernia recurrence were not detected

Three patients [2.5%] had hydrocele after surgery. In all patients, the surgical outcomes were satisfactory

Conclusions: According to the results, simultaneous prostatectomy and preperitoneal herniorrhaphy with mesh application is a convenient procedure which can be easily performed, furthermore it is cost effective, time-saving and achieves good outcomes for patients

Simultaneous Bilateral Anterior Inguinal Herniorrhaphy with Polypropylene Mesh Application and Open Prostatectomy.

Aims: Lower urinary tract symptoms (LUTS) are common in aging men. Benign prostatic hyperplasia (BPH) develops with advancing age. The incidence of inguinal hernia also increases with age. A significant number of elderly men with symptoms of BPH have inguinal hernia at the same time. Simultaneous preperitoneal inguinal hernia repair with other pelvic surgeries has been described, but it was not popular among urologists and general surgeons mainly because of high recurrence rate. Study Design: Prospective study. Place and Duration of Study: Department of Urology, Tabriz University of Medical Sciences, Imam Reza Hospital, between March 2010 and September 2013 Methodology: We evaluated the outcomes and complications of 37 patients who underwent open transvesical prostatectomy and simultaneous bilateral preperitoneal herniorrhaphy with application of polypropylene mesh Results: Twelve patients with bilateral direct hernia, 24 patients with bilateral indirect hernia and one patient with right side direct and left side indirect inguinal hernia were enrolled in our study. Four patients (10.8%) had bilateral recurrent hernias and 2 others (5.4%) had recurrent hernia on one side and primary hernia on the other side. Mean operation time was 86 minutes (71-110). The mean blood loss during surgery was 578 (240-1250)ml. The median clinical follow-up time was 13.7 months. During follow-up period surgical site infection, hematoma, chronic pain and recurrence were not detected. One (2.7%) lymphocele formation was detected. In all patients, the surgical outcomes were satisfactory. Conclusion: Simultaneous prostatectomy and preperitoneal herniorrhaphy with mesh application, is a convenient and safe procedure which can be performed easily by urologists. This procedure is both cost effective and time-saving and achieves long term beneficial outcomes for patients.

Uroflowmetry findings in patients with bladder outlet obstruction symptoms in standing and crouching positions

Bladder emptying in crouching position is a conventional way in many eastern countries. Our aim was to evaluate uroflowmetry parameters as an index of obstruction severity in standing and crouching positions and comparison of them in patients with bladder outlet obstruction symptoms. Uroflowmetry in standing and crouching positions was done in 83 patients with bladder outlet obstruction symptoms due to benign prostatic hyperplasia [BPH]. The patients were 50 years old or older and their maximum flow rate in standing position was less than 15 mL/s. The maximum flow rate, average flow rate, maximum flow time, and postvoid residual urine volume were measured and recorded. The results in standing and crouching positions were compared. The mean maximum flow rate and mean average flow rate in crouching position increased 86% and 51%, respectively [P <.001; P =.012], while mean maximum flow time and postvoid residual volume decreased 40% and 46%, respectively [P <.001; P <.001]. These changes were also significant in patients with maximum flow rates of less than 10 mL/s and 10 mL/s to 15 mL/s in standing position, except for the maximum flow time in the latter group. A more complete emptying of bladder in crouching position in patients with BPH can be attributed to the increased bladder pressure due to a good transmission of intra-abdominal pressure and a complete and coordinated relaxation of pelvic floor muscles. This position can help improve patients' symptoms