联合膀胱切开的耻骨后保留尿道粘膜前列腺切除术(附62例报告)

改良Ｍａｄｉｇａｎ术式，采用联合膀胱切开的耻骨后保留尿道粘膜前列腺切除术的方法治疗６２例前列腺增生症患者。其中５１例获随访，最长时间达３６个月。结果显示本改良术式保留了Ｍａｄｉｇａｎ术式术后出血少、恢复快的特点，同时又能处理膀胱内的病变，中叶增生的患者同样获满意疗效，进一步扩大了Ｍａｄｉｇａｎ术式的适应证。     

Effect of vasectomy via inguinal canal on spermatogenesis in rabbits

Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-nine normal male Japanese white rabbits （aged 4- 6 months） were subjected to unilateral close-ended （conventional） or open-ended （the cut end of the juxta-epididymal vas deferens not ligated） vasectomy via the inguinal canal. Ten days and 3 months after operation, testes, epididymides and vasa deferentia were removed and methacrylate resin-embedded sections prepared. The histology of the testis, epididymis and vas deferens was examined under light microscope, and the volume and diameter of the seminiferous tubules were quantitatively studied using stereological methods. Results： Neither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral shamoperated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation. Conclusion： Vasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.     

Synchronous suprapubic prostatectomy and inguinal herniorrhaphy

Synchronous suprapubic prostatectomy and inguinal herniorrhaphy were performed on 12 patients who presented with benign prostatic hypertrophy and concurrent inguinal hernia(s). The results of these were compared with those of 12 other (control) patients, matched for age, who presented with benign prostatic hypertrophy only and who had suprapubic prostatectomy by the same surgical team under similar operative conditions. The results showed that while the additional herniorrhaphy increased the operating time by 30 min and increased the mean blood loss by 250 ml, it did not carry any other significant morbidity. This approach eliminates multiple hospitalisation and operations, multiple anaesthesia and prolonged catheterisation, and lowers the high cost of hospitalisation.     

Combined transurethral prostatectomy and inguinal hernioplasty

Aim  

Evaluation of combined transurethral resection of the prostate (TURP) and inguinal hernia repair with Vypro II mesh in comparison with patients undergoing TURP and hernioplasty sequentially.     

Subcutaneous sacrococcygeal ependymoma with inguinal lymph node metastasis. Case report

A patient with a subcutaneous sacrococcygeal ependymoma and metastasis to the inguinal lymph nodes is presented and his treatment is described. Previous reports on sacrococcygeal ependymoma are reviewed.     

Combined retropubic prostatectomy and preperitoneal inguinal herniorrhaphy

Inguinal hernia and an enlarged prostate causing urinary obstruction are 2 disorders with a higher frequency among elderly patients. The anatomical proximity of an inguinal hernia to the enlarged prostate raises the possibility of joint, concurrent surgical treatment of both disorders. We report on the successful preperitoneal repair via a Pfannenstiel incision of 131 inguinal hernias in 97 patients who had undergone retropubic prostatectomy owing to benign enlargement of the prostate. Followup averaged 7 years and included 91 patients with 122 direct and indirect, unilateral or bilateral hernias. Summation of our results shows a low recurrence rate (4.9 per cent) and no complications in the wake of the combined operation. In our opinion prostatectomy combined concurrently with inguinal hernia repair via a preperitoneal retropubic approach should be applied routinely in urological practice.     

Combined inguinal herniorrhaphy and transurethral prostatectomy.

Between January 1979 and June 1988, 41 men underwent combined inguinal herniorrhaphy and transurethral prostatectomy at the Instituto Nacional de la Nutrición in México. These cases (group 1) were compared retrospectively with 100 consecutive cases of inguinal herniorrhaphy alone (group 2) and 100 consecutive cases of transurethral prostatectomy alone (group 3) during the same period. Group 1 had the highest incidence of preoperative risk factors because of age and associated medical problems. However, there were no significant differences in the rate of operative or postoperative complications between groups. No recurrences of inguinal hernia were recorded in group 1 after a follow-up period of 47.1 months. The length of hospitalization was similar between groups, and no patient died. Our observations suggest that when an inguinal hernia and symptomatic prostatism occur together, combined inguinal herniorrhaphy and transurethral prostatectomy is a practical, safe and effective operative procedure. The advantages of this combined procedure include one anaesthetic period, one operative procedure, one hospital stay and one convalescence with morbidity and mortality rates that are comparable to those of inguinal herniorrhaphy or transurethral prostatectomy alone.     

Transabdominal inguinal hernioplasty combined with abdominal aortic aneurysm repair

(Received for publication on Mar. 12, 1998; accepted on Sept. 11, 1998)     

Laparoscopic inguinal hernia repair during laparoscopic radical prostatectomy

OBJECTIVE: To describe our experience of simultaneous laparoscopic radical prostatectomy (LRP) and inguinal hernia repair (LIHR) with a non-absorbable mesh, as there are few reports of simultaneous herniorrhaphy during LRP. PATIENTS AND METHODS: Forty patients who had simultaneous LIHR and LRP were retrospectively reviewed. All operations were completed via antegrade techniques using a non-absorbable mesh for the LIHR, as the results with absorbable mesh were disappointing. RESULTS: In all, 48 clinically apparent hernias were repaired in 40 patients (mean age 60 years). Of these, 13 were left-sided, 23 right-sided, and six bilateral; 19 were direct, 14 indirect, two pantaloon, three femoral, and in 10 the type was not recorded. The mean operative duration was 172 min and the mean hospital stay was 1.5 days. Two patients had a urine leak after surgery, which resolved with no further intervention, and two developed a pelvic lymphocele, one at 4 months and the other at 2 months after surgery. Two patients required urinary catheter re-insertion for retention after surgical catheter removal at 9 and 10 days after surgery, respectively. One patient developed a deep venous thrombosis 19 days after surgery. Of the 40 patients, 36 (90%) were followed for a mean of 10 months; none had a hernia recurrence on the repaired side, while two developed a new symptomatic contralateral hernia. CONCLUSIONS: LIHR is a successful and reliable way to treat symptomatic patients who are treated surgically for prostate cancer.     

Laparoscopic inguinal hernioplasty after robot-assisted laparoscopic radical prostatectomy

Purpose

To evaluate the efficacy and safety of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RALP).

Methods

From July 2014 to December 2016, TAPP inguinal hernia repair was conducted in 40 consecutive patients who had previously undergone RALP. Their data were retrospectively analyzed as an uncontrolled case series.

Results

The mean operation time in patients who had previously undergone RALP was 99.5 ± 38.0 min. The intraoperative blood loss volume was small, and the duration of hospitalization was 2.0 ± 0.5 days. No intraoperative complications or major postoperative complications occurred. During the average 11.2-month follow-up period, no patients who had previously undergone prostatectomy developed recurrence.

Conclusions

Laparoscopic TAPP inguinal hernia repair after RALP was safe and effective. TAPP inguinal hernia repair may be a valuable alternative to open hernioplasty.

     

Transperitoneal robotic-assisted laparoscopic radical prostatectomy and inguinal herniorrhaphy

Patients undergoing radical prostatectomy are at increased risk of development of post-operative inguinal hernias (IH). We present the largest series of transperitoneal combined robotic-assisted laparoscopic prostatectomy (RALP) and IH. After IRB approval, data from patients undergoing RALP at two centers were prospectively entered into a database and analyzed. IH were repaired robotically via a transperitoneal route with mesh. Between June 2002 and May 2007, 837 RALPs were performed, 80 of which included combined IH repair (9.6%), by two surgeons, T.A. and D.S. Forty-two patients (52.5%) had IH on pre-operative exam. Twenty-four hernias were left, 32 right, and 24 bilateral. Twenty-two patients had prior ipsilateral or contralateral herniorrhaphy. After dissection of the hernia sac, a swatch of flat Marlex mesh (n = 22), a polypropylene mesh plug (n = 19), an Ultrapro hernia system (n = 7), a Proceed coated mesh (n = 19), a 3D-Max (n = 37), a combination of both umbrella and flat mesh (n = 3), or suture alone (n = 2) was used. Inguinal herniorrhaphy added approximately 15 min of operative time in all cases. There was one hernia recurrence over an average follow-up period of 12.5 months (0.2–52 months). There was one complication attributable to IH repair—a urine leak which was attributed to anastomotic stretch due to reperitonealization. Urological surgeons should perform a thorough inguinal exam during preoperative evaluation and intraoperatively to detect subclinical inguinal hernias. Inguinal herniorrhaphy at the time of RALP is safe and should be routinely performed.     

Consequences of endoscopic inguinal hernioplasty with mesh on subsequent open radical prostatectomy

AIM: To determine the effect of prior endoscopic hernia repair with prosthetic mesh on subsequent open radical prostatectomy. METHODS: A retrospective study from 1990 to 2004 identified nine patients with preperitoneal mesh placement followed by open radical prostatectomy. Case controls (n = 26) were matched for age, type of operation, year of surgery and pathologic stage of prostatic adenocarcinoma. Outcome variables of operating time, number of pelvic lymph nodes excised, duration of hospital stay, duration of urinary catheterization, recurrence rates, and incidence of complications were compared. Data analysis was performed using Wilcoxon's rank sums test. RESULTS: Intraoperatively, subjective difficulty in dissection was documented in all cases by the performing urologist. Duration of hospital stay was significantly increased by 1.3 days (p < 0.05), as compared to the control group. However, no statistically significant increase in mean operating time (173 vs. 172 min, p = 0.925), number of lymph nodes sampled (4.4 vs. 6.6, p = 0.147), duration of urinary catheterization (22 vs. 19 days, p = 0.925), oncologic recurrence (11 vs. 11% at 6.1 and 4.8 years follow-up), or complications was found. CONCLUSIONS: Prior TEP/TAPP did not increase the morbidity or mortality of subsequent prostate surgery. Despite some subjective operative difficulty, open prostatectomy was safe and feasible in all cases with a comparable oncologic outcome. Mesh-associated inflammation may preclude adequate nodal sampling. While endoscopic hernia repair remains an excellent option to fix unilateral, bilateral, and recurrent herniae, consideration of future prostate surgery is important. Inserting less "inflammatory" mesh or using an open, anterior approach may be prudent in some men at high risk for needing subsequent prostate surgery.     

Transurethral prostatectomy and inguinal hernia repair in a single session

INTRODUCTION: We aimed at evaluating the outcomes of transurethral prostatectomy and inguinal hernia repair performed in a single session. PATIENTS AND METHODS: Fifty-six patients (mean age 68+/-8.3 years) in whom transurethral prostatectomy was performed combined with an inguinal hernia repair were included into the study. Type of anesthesia, technique of inguinal hernia repair, hospitalization time, and the complications encountered were recorded. Cost comparisons were made using the official price-lists of the Turkish Medical Association. All patients were asked whether they were satisfied with the outcome of both operations performed in one session. The data obtained from the patients who underwent both operations in one session were compared with those obtained from 56 patients who underwent transurethral prostatectomy only (control group). Statistical analysis was performed using the chi-square test corrected for continuity according to the Yates or the Fisher exact test. RESULTS: The operations were performed in 19 patients under general, in 20 patients under epidural, and in 14 patients under spinal anesthesia. Three patients were given general anesthesia and spinal anesthesia combined. In 6 patients bilateral and in 50 patients unilateral hernia repair was performed. In 11 repairs, polyprolene mesh grafts were utilized; in 2 repairs, a laparoscopic method was used, and in the remaining 49 repairs, one of the conventional techniques (McVay, Bassini, or Shouldice) was employed. There were no significant differences with regard to early and late postoperative complications and satisfaction between study group and control group (p>0.05). Combined prostatectomy and hernia repair allows approximately 30% cost profit. CONCLUSIONS: Performing transurethral prostatectomy and inguinal hernia repair in one session decreased the number of the operations and anesthesias, hospital stay, and thus health costs and did not cause an increase in operative and postoperative morbidity.