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      Incidence and risk factors of inguinal hernia occurred after radical prostatectomy-comparisons of different approaches

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          Abstract

          Background

          To observe cumulative morbidity of postoperative inguinal hernia (PIH) and identify risk factors associated with its development in patients who underwent retropubic radical prostatectomy (RRP), laparoscopic prostatectomy (LRP) or robotic assisted laparoscopic prostatectomy (RALP) operation.

          Methods

          From June 2009 to September 2016, 756 patients diagnosed with localized prostate cancer who had undergone RRP, LRP or RALP in our center were included in this study. Patients with PIH were retrospectively investigated in such factors as age, BMI, previous abdominal operations, diabetes mellitus history, hypertension history, prostate volume, previous hernia, operative methods, operative approach, preoperative Gleason, clinical T-stage, PLND situation, operative time, and estimated blood loss. Univariate and multivariate cox hazard regressions analysis were utilized to identify risk factors predisposing to PIH.

          Results

          A total of 53 of 751(7.1%) patients developed PIH at a median follow-up period of 43 months. PIH rate in RRP was significantly higher compared to LRP and RALP group (RRP: 15.3%, LRP: 6.7%, RALP:1.9%, P = 0.038). Right side (69.8%) and indirect (88.8%) PIH were dominant type in hernia group. Univariate and multivariate cox hazard regressions analysis indicated that age and RRP approach were identified to be implicated to PIH [adjusted hazard ratio7.39(1.18–46.39), 2.93(95% CI 1.47–5.84)].

          Conclusions

          RRP technique and older age, especially patients over 80 years, are associated with higher incidence for PIH development. Appropriate prophylaxis during the operation should be evaluated for those in high-risk.

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          Most cited references24

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          Staging of prostate cancer.

          Prostatic carcinoma (PCa) is a significant cause of cancer morbidity and mortality worldwide. Accurate staging is critical for prognosis assessment and treatment planning for PCa. Despite the large volume of clinical activity and research, the challenge to define the most appropriate and clinically relevant staging system remains. The pathologically complex and uncertain clinical course of prostate cancer further complicates the design of staging classification and a substaging system suitable for individualized care. This review will focus on recent progress and controversial issues related to prostate cancer staging. The 2010 revision of the American Joint Committee on Cancer/Union Internationale Contre le Cancer (AJCC/UICC) tumour, node and metastasis (TNM) system is the most widely used staging system at this time. Despite general acceptance of the system as a whole, there is controversy and uncertainty about its application, particularly for T2 subclassification. The three-tiered T2 classification system for organ-confined prostate cancer is superfluous, considering the biology and anatomy of PCa. A tumour size-based substaging system may be considered in the future TNM subclassification of pT2 cancer. Lymph node status is one of the most important prognostic factors for prostate cancer. Nevertheless, clinical outcomes in patients with positive lymph nodes are variable. Identification of patients at the greatest risk of systemic progression helps in the selection of appropriate therapy. The data suggest that the inherent aggressiveness of metastatic prostate cancer is closely linked to the tumour volume of lymph node metastasis. We recommend that a future TNM staging system should consider subclassification of node-positive cancer on the basis of nodal cancer volume, using the diameter of the largest nodal metastasis and/or the number of positive nodes. © 2011 Blackwell Publishing Limited.
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            Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden.

            To quantify complications to surgery in patients treated with robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) at our institution. Radical prostatectomy is associated with specific complications that can affect outcome results in patients. Between January 2002 and August 2007, a series of 1738 consecutive patients underwent RARP (n = 1253) or RRP (n = 485) for clinically localized prostate cancer. Surgery-related complications were assessed using a prospective hospital-based complication registry. The baseline characteristics of all patients were documented preoperatively. Overall, 170 patients required blood transfusions (9.7%), 112 patients (23%) in the RRP group compared with 58 patients (4.8%) in the RARP group. Infectious complications occurred in 44 RRP patients (9%) compared with 18 (1%) in the RARP group. Bladder neck contracture was treated in 22 (4.5%) patients who had undergone RRP compared with 3 (0.2%) in the RARP group. Clavien grade IIIb-V complications were more common in RRP patients (n = 63; 12.9%) than in RARP patients (n = 46; 3.7%). The introduction of RARP at our institution has resulted in decreased number of patients with Clavien grade IIIb-V complications, such as bladder neck contractures, a decrease in the number of patients who require blood transfusions, and decreased numbers of patients with postoperative wound infections. Copyright 2010 Elsevier Inc. All rights reserved.
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              Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s.

              I Rutkow (1998)
              Such important, yet basic, questions as the percentage chance that an individual will over the course of his or her life be in need of or actually undergo a groin herniorrhaphy or the absolute number and type of hernias that exist in a given society on any particular day continue to be statistically undefined. A review of epidemiologic data provides come preliminary answers. Recent studies from the National Center for Health Statistics show that approximately 750,000 groin herniorrhaphies are completed annually in the United States. More than 80% of these operations involve the use of mesh prosthesis and are performed on an outpatient basis. Despite the large number of hernioplasties completed, the public's understanding of hernias and their management remains unsophisticated.
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                Author and article information

                Contributors
                lljnj2013@163.com
                ws0801@hotmail.com
                Journal
                BMC Surg
                BMC Surgery
                BioMed Central (London )
                1471-2482
                2 October 2020
                2 October 2020
                2020
                : 20
                : 218
                Affiliations
                [1 ]GRID grid.412676.0, ISNI 0000 0004 1799 0784, Department of General Surgery, , The First Affiliated Hospital of Nanjing Medical University, ; Nanjing, Jiangsu 210029 People’s Republic of China
                [2 ]GRID grid.412676.0, ISNI 0000 0004 1799 0784, Department of Urology, , The First Affiliated Hospital of Nanjing Medical University, ; Nanjing, Jiangsu 210029 People’s Republic of China
                [3 ]Medical Council of Mauritius, One Way Floreal Road, Cite Magalkhan, Floreal, Vacoas-Phoenix, Mauritius
                Article
                883
                10.1186/s12893-020-00883-9
                7532612
                33008371
                2d09e60a-9556-4d9e-9162-83c55163ca8c
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.

                History
                : 29 June 2020
                : 24 September 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Surgery
                postoperative inguinal hernia,prostatectomy,older age,prostate cancer
                Surgery
                postoperative inguinal hernia, prostatectomy, older age, prostate cancer

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