Laparoscopic hernia repairs may make subsequent radical retropubic prostatectomy more hazardous
A.J. Cornaby, Consultant Urologist, Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK.
A 69-year-old man went to his GP to request a PSA test, the result showing a level of 2.5 ng/mL. He was subsequently shown to have a malignancy in his prostate (Gleason 2 + 1 = 3), stage T1C disease. After appropriate counselling he opted for radical retropubic prostatectomy. He had had bilateral laparoscopic hernia repairs 5 years previously. During the radical prostatectomy he was found to have very dense adhesions between his prostate and the pelvic side walls, and it was impossible to proceed safely; the procedure was therefore abandoned. The patient has subsequently had radical radiotherapy, from which he fared well.
Radical retropubic prostatectomy is becoming a more common urological procedure. Many patients have had previous inguinal hernia repairs, which do not usually cause any problems during radical retropubic prostatectomy. However, the mesh used in laparoscopic inguinal hernia repairs may cause an intense fibrotic reaction that may make the dissection to expose the endopelvic fascia very difficult. There has been one previous report  of this complication arising during radical retropubic prostatectomy, but this complication is not widely known. This should therefore be considered when counselling patients who have had previous laparoscopic hernia repairs, and who wish to have radical retropubic prostatectomy. These patients may be more suitable for a perineal approach or radical radiotherapy.