Inguinal hernia after radical perineal prostatectomy: comparison with the retropubic approach.

OBJECTIVES: To clarify the characteristics of inguinal hernia (IH) after radical perineal prostatectomy (RPP) compared with that after radical retropubic prostatectomy (RRP). METHODS: We retrospectively reviewed 285 and 311 men who underwent RPP and RRP, respectively, for clinically localized prostate cancer between August 2000 and June 2006, using medical records and a telephone survey. RESULTS: The incidence of postoperative IH after RPP was 1.8% (5 of 285) with a median follow-up time of 43 months; that after RRP was 10.3% (32 of 311) with a median follow-up of 36 months (P <0.0001). The cumulative IH-free rate was significantly higher after RPP than after RRP (P <0.0001, log-rank test). Three of the five RPP patients (60%) developed IH more than 24 months after surgery, whereas 25 of 32 (78%) of the RRP group did so within 24 months (P = 0.0742). The incidence rate of post-RPP IH did not differ between the standard (4 of 194 = 2.1%) and modified (1 of 91 = 1.1%) RPP procedures, where the endopelvic fascia was left intact and opened, respectively (P = 0.5638). CONCLUSIONS: The incidence of IH after RPP appears to be sporadic and about the same as that (2.0-2.4%) reported previously in men with prostate cancer treated nonsurgically. Although some kinds of procedures during RRP are speculated to affect the internal inguinal ring, prostatectomy with or without opening of the endopelvic fascia seems to be less implicated in the development of IH after RRP because it was not a significant variable in IH development after different techniques had been used in RPP.

Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery.

OBJECTIVE: The aim of this study was to clarify whether intravesical recurrence of upper urinary tract cancer after treatment is related to the mode of surgery or other oncological factors. METHODS: We evaluated 106 patients (mean age 70.4 years; mean follow-up 24.0 months) who underwent surgery for the upper urinary tract cancer at Hiroshima University and its affiliated hospitals between January 1995 and August 2005. Seventy-nine of the patients underwent retroperitoneoscopy-assisted radical nephroureterectomy (RN) and 27 underwent nephroureterectomy by open surgery (OS). Fifty-two patients had renal pelvic tumors, 48 had ureteral tumors, and six had both renal pelvic and ureteral tumors. Twenty-eight (26%) of the 106 patients had a pre-operative history of bladder cancer. We identified the risk factors predicting intravesical recurrence of upper urinary tract cancer according to the type of previous surgery using the Kaplan-Meier method, log-rank test, and univariate and multivariate analysis using the Cox proportional hazards model. RESULTS: Thirty-one (29%) of the 106 patients developed bladder tumors post-operatively. The 2-year intravesical recurrence-free rate was 55% in the RN group and 60% in the OS group. There was no significant difference (P = 0.51, log-rank test) in the rate of intravesical recurrence between the two groups. Multivariate analysis identified only a history of pre-operative bladder tumor (HR = 3.25, P = 0.003) as a predictor of post-operative intravesical recurrence. CONCLUSIONS: Intravesical recurrence after surgery for upper urinary tract cancer is not related to the mode of surgery (i.e. laparoscopy-assisted or open surgery) employed. The only risk factor for intravesical recurrence is a history of bladder cancer.