Oncology Predictors of Inguinal Hernia After Radical Prostatectomy Farhang Rabbani, Luis Herran Yunis, Karim Touijer, and Mary S. Brady OBJECTIVES To determine the significant independent predictors of inguinal hernia development after radical prostatectomy (RP) so that prophylactic measures can be undertaken in those at increased risk. Although inguinal hernia is a recognized complication after RP, the risk factors have not been well elucidated. METHODS From January 1999 to June 2007, 4592 consecutive patients underwent open retropubic RP or laparoscopic RP without previous radiotherapy. The median follow-up was 36.9 months (inter- quartile range 20.3, 60.6). Comorbidities were recorded, as well as the occurrence of inguinal hernia, wound infection, and bladder neck contracture. Cox proportional hazards analysis was performed for the predictors of inguinal hernia after RP on multivariate analysis. RESULTS Inguinal hernia developed after RP in 68 men (1.5%) men at a median follow-up of 7.9 months (interquartile range 4.3, 18.1). The laterality was bilateral in 7, right in 27, left in 24, and not documented in 10 patients. The significant independent predictors of inguinal hernia included age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.01-1.09, P = .016), body mass index (HR 0.91, 95% CI 0.85-0.98, P = .011), history of inguinal hernia repair (HR 3.9, 95% CI 1.8-8.2, P .001), and bladder neck contracture (HR 2.8, 95% CI 1.3-5.9, P = .007) but not the RP approach (HR 1.08, 95% CI 0.60-1.96, P = .80 for laparoscopic RP vs retropubic RP). CONCLUSIONS The results of our study have indicated that older patients, thinner patients, those with previous inguinal hernia repair, and those developing bladder neck contracture are at increased risk of developing an inguinal hernia. These factors might identify a subset for whom evaluation for subclinical hernia might allow prophylactic inguinal hernia repair at RP. UROLOGY 77: 391–395, 2011. © 2011 Elsevier Inc. S ince the initial study by Regan et al. 1 reporting a 12% incidence of inguinal hernia within 6 months after radical prostatectomy (RP), inguinal hernia has been well recognized as a complication of RP, with an incidence of 2.9% after minilaparotomy retropubic RP (RRP) to 39% after conventional RRP. 2 Although the mechanism for this is unknown, several hypotheses have been postulated. Subclinical inguinal hernias have been reported in 10%-33% of men undergoing RP, 3-6 consis- tent with the 20% rate reported in autopsy studies 7 and the 5%-27% reported lifetime prevalence 8-10 ; these subclinical hernias might manifest as clinical hernias after RP. The prevailing hypothesis is that disruption of the posterior rectus sheath loosens the transversus aponeuro- sis, which might weaken the internal inguinal ring. 11,12 Ischemia from self-retaining retractors has been proposed as a potential mechanism for post-RRP inguinal her- nia. 1,13,14 Alternatively, the reduction of preperitoneal fat at prostatectomy might allow bowel to enter the inguinal ring and lead to the development of a symptom- atic hernia. 15 However, the incidence of inguinal hernia after laparoscopic RP (LRP) has been reported to be as great as that after open retropubic RP (RRP). 16 The potential risk factors reported to be associated with in- guinal hernia after RP include older patient age, 13,17,18 lower body mass index (BMI), 14,19 bladder neck contrac- ture (BNC), 13 wound infection, 20 and a history of ingui- nal hernia. 13,14,17,19,20 We sought to determine the sig- nificant predictors of inguinal hernia after RP in a contemporary series so that prophylactic measures, such as pre-emptive inguinal hernia repair at RP could be undertaken in those at increased risk. MATERIAL AND METHODS From January 1999 to June 2007, 4592 consecutive patients underwent RRP (n = 3458) or LRP (n = 1134, including 97 robotic cases) for adenocarcinoma of the prostate without pre- vious radiotherapy at our institution. Data were collected from a prospective prostatectomy database and a prospective institu- tional morbidity database. Additional data were obtained from This study was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers. From the Department of Urology, Montefiore Medical Center, Bronx, New York; and Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York Reprint requests: Farhang Rabbani, M.D., Department of Urology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490. E-mail: frabbani@ montefiore.org Submitted: February 9, 2010, accepted (with revisions): April 10, 2010 © 2011 Elsevier Inc. 0090-4295/11/$36.00 391 All Rights Reserved doi:10.1016/j.urology.2010.04.019