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      Incidence and risk factors of inguinal hernia after robot-assisted radical prostatectomy

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          Abstract

          Background

          Robot-assisted radical prostatectomy (RARP) has now become a gold standard approach in radical prostatectomy. The aim of this study was to investigate incidence and risk factors of inguinal hernia (IH) after RARP.

          Methods

          This study included 307 consecutive men who underwent RARP for the treatment of prostate cancer from January 2011 to August 2015. The incidence of IH after RARP was investigated. Clinical and pathological factors were also investigated to assess relationship with development of postoperative IH.

          Results

          Median follow-ups were 380 days, and median age of patients was 67 years. Incidence of IH was 11.3, 14.0, and 15.4% at 1, 2, and 3 years after RARP, respectively. Postoperative IH occurrence was significantly associated with low surgeon experience and postoperative incontinence at 3 or 6 months after surgery ( P = 0.019, P = 0.002, and P = 0.016, respectively).

          Conclusions

          Most of the IH occurred within the first 2 years with a rate of 14%. Incidence of IH after RARP was significantly associated with surgical experience and incontinence outcomes.

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          Most cited references 21

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          Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies.

          Several factors influence the risk of recurrence after inguinal hernia surgery; however, a systematic review and meta-analysis of patient-related risk factors for recurrence after inguinal hernia surgery has not been performed earlier.
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            Vattikuti Institute prostatectomy: technical modifications in 2009.

            Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients. To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results. Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon. The superveil nerve-sparing technique spares nerves from the 11-o'clock position to the 1-o'clock position. The bladder is drained with a PST rather than a urethral catheter. For low- or intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes. Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist. At 6-18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%). In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes.
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              Body mass index and groin hernia: a 34-year follow-up study in Swedish men.

              Inguinal hernias are very common disorders, especially in men, with inguinal herniorrhaphy being one of the most frequently performed general surgical procedures in men. Theoretically, obesity might increase the risk of groin hernia by increasing intra-abdominal pressure. The objective of the present study was to investigate whether overweight and obesity in middle age could significantly predict future groin hernia in men. Prospective cohort study; General population of men living in Gothenburg, Sweden; A community-based sample of 7483 men aged 47 to 55 years were followed-up from baseline (1970-1973) for a maximum of 34 years. A diagnosis of groin hernia according to the Swedish hospital discharge register. A total of 1017 men (13.6%) were diagnosed with groin hernia. An inverse relationship was found between body mass index (BMI) and risk of groin hernia. With each BMI unit (3-4 kg), the relative risk for groin hernia decreased by 4% (P < 0.0001). Compared with men of normal weight, obese men had a 43% lower risk (P = 0.0008, 95% confidence interval 21%-59%). Heavy smokers demonstrated a 26% lower risk for groin hernia (P = 0.003, 95% confidence interval 10%-39%). Diabetes, high physical activity, and blood pressure were not associated with groin hernia. Entering other variables potentially associated with groin hernia, as age, BMI, smoking, and serum cholesterol, in a multivariable analysis left the risk estimates for BMI and smoking virtually unchanged. In a large community-based sample of middle-aged men overweight and obesity were associated with a lower risk for groin hernia during an extended follow-up. Obesity, in comparison with normal weight, reduced the risk of groin hernia by 43%. A reduced risk of groin hernia was also noted in heavy smokers. Obviously, hernia may be more easily detected in lean men but a true protective effect cannot be excluded.
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                Author and article information

                Contributors
                yyamada2029@gmail.com
                81-3-5800-8662 , fujimurat-uro@h.u-tokyo.ac.jp
                fukuharah-uro@h.u-tokyo.ac.jp
                ezy04707@nifty.com
                hama_irino@yahoo.co.jp
                kakushigean@yahoo.co.jp
                suzukim-uro@h-u-tokyo.ac.jp
                tohru-tky@umin.ac.jp
                kume@kuc.biglobe.ne.jp
                yigawa-jua@umin.ac.jp
                homma-uro@umin.ac.jp
                Journal
                World J Surg Oncol
                World J Surg Oncol
                World Journal of Surgical Oncology
                BioMed Central (London )
                1477-7819
                16 March 2017
                16 March 2017
                2017
                : 15
                Affiliations
                [1 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, Department of Urology, Graduate School of Medicine, , The University of Tokyo, ; Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
                [2 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, Continence Medicine, Graduate School of Medicine, , The University of Tokyo, ; Bunkyo-ku, Tokyo, Japan
                [3 ]ISNI 0000 0001 0016 1697, GRID grid.414994.5, Department of Urology, , Tokyo Teishin Hospital, ; Chiyoda-ku, Tokyo, Japan
                Article
                1126
                10.1186/s12957-017-1126-3
                5353804
                28302122
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2017

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