San Carlo di Nancy Hospital, Roma, Italia.
Departamento de Urología, Fundación IVO, Valencia, España.
Actas Urol Esp (Engl Ed). 2020 Apr;44(3):131-138. doi: 10.1016/j.acuro.2019.10.005. Epub 2020 Feb 10.
We aimed to perform a systematic review about the relationship between inguinal hernia and surgery for prostate cancer.
Diagnosis of abdominal wall defects and prostate cancer may be either synchronous or metachronous. The convenience and safety of combined prostatectomy and hernioplasty, the incidence of hernias after prostatectomy and the feasibility of prostatectomy in patients with previous laparoscopic hernioplasty are still debated.
PubMed and Embase were queried by dedicated search strings. Two researchers independently reviewed the pooled references and selected the articles of interest, including reviews.
Sixty-five studies were evaluated, 22 of them analysed the feasibility and the outcomes of a combined surgery, namely one-stage radical prostatectomy and herniorrhaphy or hernioplasty. Literature evidences support the combined intervention to patients suffering from an inguinal hernia and a prostate cancer amenable of radical prostatectomy. Sixteen studies addressing the potential increase in the occurrence of inguinal hernia after radical prostatectomy were evaluated. Approximately 15% of patients who undergo retro-pubic radical prostatectomy will develop inguinal hernia. It is suggested that the incidence might be lower in laparoscopic prostatectomy series, particularly in case of transperitoneal approach. The median time to the appearance of the hernia is around 6 months. After evaluation of 14 studies, it is concluded that laparoscopic hernioplasty does not preclude prostatectomy but hinders further pelvic surgery.
One-stage combined hernioplasty and radical prostatectomy may be accepted except in cases of lymph-nodes dissection and/or positive hydro-distress test of the urethro-vesical anastomosis. Accurate patient's counselling and dedicated consent form are mandatory, in the setting of an experienced multidisciplinary team.
我们旨在对腹股沟疝与前列腺癌手术之间的关系进行系统评价。
腹壁缺损和前列腺癌的诊断可以是同时发生的，也可以是相继发生的。同期行前列腺切除术和疝修补术的便利性和安全性、前列腺切除术后疝的发生率以及既往腹腔镜疝修补术后患者行前列腺切除术的可行性仍存在争议。
通过专用搜索词对 PubMed 和 Embase 进行了检索。两位研究人员独立审查了汇总的参考文献，并选择了有意义的文章，包括综述。
评估了 65 项研究，其中 22 项分析了联合手术的可行性和结果，即一期根治性前列腺切除术和疝修补术或疝成形术。文献证据支持对患有腹股沟疝和可根治性前列腺癌的患者进行联合干预。评估了 16 项探讨根治性前列腺切除术后腹股沟疝发生潜在增加的研究。约 15%接受耻骨后根治性前列腺切除术的患者会发生腹股沟疝。有人建议，在腹腔镜前列腺切除术系列中，特别是在经腹腔入路的情况下，发病率可能较低。疝的出现中位时间约为 6 个月。在评估了 14 项研究后，得出的结论是腹腔镜疝修补术并不妨碍前列腺切除术，但会妨碍进一步的盆腔手术。
除非存在淋巴结清扫和/或尿道膀胱吻合口的水压力试验阳性，否则一期联合疝修补术和根治性前列腺切除术可能是可以接受的。在经验丰富的多学科团队中，必须对患者进行准确的咨询并签署专门的同意书。
