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Incidence and risk factors of inguinal hernia after robot-assisted radical prostatectomy: a retrospective multicenter cohort study in Japan (the MSUG94 group)

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Abstract

To investigate the incidence and risk factors of inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) using a multicentric database. The present study used a multicentric database (the MSUG94) containing data on 3,195 Japanese patients undergoing RARP between 2012 and 2021. Surgical procedures utilized for IH prevention were as follows: isolation of the vas deferens, transection of the vas deferens, isolation of the spermatic vessels, and separation of the peritoneum from the internal inguinal ring. The primary and secondary endpoints were IH-free survival and any association between post-RARP IH and clinical covariates. The prophylactic effect of the above procedures were also assessed. IH prevention was attempted in 1,465 (46.4%) patients at five of the nine hospitals. During follow-up (median 24 months), post-RARP IH developed in 243 patients. The post-RARP IH-free survival rates at years 1, 2, and 3 were 94.3%, 91.7%, and 90.5%, respectively. Old age (hazard ratio [HR] 1.037; 95% confidence interval [CI] 1.014–1.061; p = 0.001), low BMI (HR 0.904; 95% CI 0.863–0.946: p < 0.001), and low hospital volume (HR 1.385; 95% CI 1.003–1.902; p = 0.048) were independently associated with IH development. None of the procedures for IH prevention were associated with IH development. Our findings may represent the current, real-world status of post-RARP IH in Japan. The prophylactic effects of the surgical procedures for IH prevention should be further investigated in well-designed, prospective studies to optimize the surgical technique.

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Data availability

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical reasons.

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Funding

This study did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan

    Masahiro Toide & Fumitaka Koga

  2. Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Shin Ebara

  3. Department of Urology, Yokohama City University, Yokohama, Japan

    Tomoyuki Tatenuma & Kazuhide Makiyama

  4. Department of Urology, University of Toyama, Toyama, Japan

    Yoshinori Ikehata & Hiroshi Kitamura

  5. Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan

    Akinori Nakayama & Kazutaka Saito

  6. Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan

    Makoto Kawase & Takuya Koie

  7. Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan

    Takeshi Sasaki & Takahiro Inoue

  8. Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

    Tatsuaki Yoneda

  9. Department of Urology, Toranomon Hospital, Tokyo, Japan

    Kazushige Sakaguchi & Shinji Urakami

  10. Department of Surgery, Division of Urology, Graduate School of Medicine, Kobe University, Kobe, Japan

    Jun Teishima

Authors
  1. Masahiro Toide
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  2. Shin Ebara
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  3. Tomoyuki Tatenuma
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Contributions

MT: project development, data collection, data analysis, and manuscript writing. SE: project development, data collection, and manuscript writing. TT: data collection and manuscript writing. YI: data collection and manuscript writing. AN: data collection and manuscript writing. DK: data collection and manuscript writing. TS: data collection and manuscript writing. TY: project development, data collection, and manuscript writing. KS: data collection and manuscript writing. JT: project development, data collection, and manuscript writing. KM: project development, data collection, and manuscript writing. HK: project development, data collection, and manuscript writing. KS: project development, data collection, and manuscript writing. TK: project development, data collection, and manuscript writing. TI: project development, data collection, and manuscript writing. SU: project development, data collection, and manuscript writing. FK: project development, data collection, data analysis, and manuscript writing.

Corresponding author

Correspondence to Fumitaka Koga.

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The authors of this paper have no financial or nonfinancial interests that are directly or indirectly related to the work submitted for publication.

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Received from the Japanese Ethics Committee and Ethics Guidelines. Institutional review board approval was obtained (#2783).

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For this type of study, formal consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation.

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Toide, M., Ebara, S., Tatenuma, T. et al. Incidence and risk factors of inguinal hernia after robot-assisted radical prostatectomy: a retrospective multicenter cohort study in Japan (the MSUG94 group). J Robotic Surg 18, 38 (2024). https://doi.org/10.1007/s11701-023-01761-1

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