title: The processus vaginalis transection method is superior to the simple prophylactic procedure for prevention of inguinal hernia after radical prostatectomy.
abstract: BACKGROUND
  We compared retrospectively the efficacy of two methods for prevention of post-radical prostatectomy inguinal hernia: blunt dissection of the peritoneum at the internal inguinal ring, and isolation of the spermatic cord from the peritoneum (simple prophylactic procedure) and transection of the processus vaginalis.
  
  
  METHODS
  Of the 367 patients who underwent open radical retropubic prostatectomy for clinically localized prostate cancer between February 2005 and March 2012 at Saitama Cancer Center Hospital, 344 patients whose follow-up period was more than 2 years were enrolled in this study. Of these patients, 178 patients received the simple prophylactic procedure and 57 underwent processus vaginalis transection. We evaluated the risk factors for inguinal hernia (age; anastomotic stricture post radical prostatectomy; prophylactic procedures for inguinal hernia; previous history of abdominal surgery; previous inguinal hernia surgery; body mass index) using univariate and multivariate analysis. The effects of the two prophylactic procedures on incidence of inguinal hernia were analyzed using Kaplan-Meier plots.
  
  
  RESULTS
  The incidence of inguinal hernia was 24.8 % in those not undergoing the prophylactic procedure; 18.5 % in those undergoing the simple prophylactic procedure; and 0.00 % in those undergoing the processus vaginalis transection procedure (p < 0.001). In univariate and multivariate analysis, undergoing the processus vaginalis transection procedure and high body mass index were significant predictors for hernia-free survival after radical prostatectomy.
  
  
  CONCLUSIONS
  Our data suggest that the processus vaginalis transection procedure is superior to the simple prophylactic procedure for the prevention of inguinal hernia after radical prostatectomy.
authors.affiliation: Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-Adachi gun, Saitama, 362-0806, Japan. kanda@cancer-c.pref.saitama.jp.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kanda
authors.affiliation: Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-Adachi gun, Saitama, 362-0806, Japan.
authors.forename: Syohei
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Department of Urology, JA Toride Medical Center, Hongo 2-1-1, Toride, Ibaraki, 302-0022, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kohno
authors.affiliation: Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-Adachi gun, Saitama, 362-0806, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fukui
authors.affiliation: Department of Urology, Saitama Cancer Center, 780 Komuro, Ina, Kita-Adachi gun, Saitama, 362-0806, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kageyama
mesh_terms: D000368:Aged; D015992:Body Mass Index; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007264:Inguinal Canal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010537:Peritoneum / Q000601:surgery; D065286:Prophylactic Surgical Procedures; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013085:Spermatic Cord / Q000601:surgery*
keywords: Inguinal hernia; Processus vaginalis; Prophylaxis; Prostate cancer; Prostatectomy