Abstract:

Objective

To explore the predictive value of preoperative MRI parameters of the prostate and clinical factors for inguinal hernia （PIH） after robot-assisted radical prostatectomy （RARP）.

Methods

A retrospective case-control study was conducted to analyze the clinical data， preoperative prostate MRI and postoperative pathological reports of 469 patients who underwent RARP in the Department of Urology， the First Affiliated Hospital of Anhui Medical University from January 2020 to August 2024. According to the follow-up diagnosis results of hernia surgeons after surgery， they were divided into the case group （PIH group） and the control group （non-PIH group）. Kaplan-Meier plotted the PIH free survival curve after RARP and logistic regression analysis was used to analyze the risk factors of PIH.

Results

A total of 438 patients with RARP were included in this study. The median follow-up time was （19.3±8.6） months， and a total of 50 patients （11.4%） developed PIH. There were no statistically significant differences between the two groups in age， smoking history， alcohol consumption history， level of preoperative prostate-specific antigen， preoperative Gleason score， intraoperative pelvic lymph node dissection， duration of operation， and pathological N stage. Body mass index （BMI） and T stage of postoperative pathology were significantly different between the two groups （P＜0.05）. The 2-year PIH-free survival rates of BMI＜18.5 kg / m² and BMI≥25.0 kg / m² were 76.50 % and 92.22 %， respectively， and the difference was statistically significant （P=0.029）. The 2-year PIH-free survival rates of≤T2 and≥T3 were 91.01 % and 80.64 %， respectively， and the difference was statistically significant （P=0.037）. In prostate MRI parameters， Sag-H measured on sagittal T2-weighted images had significant differences （t=2.555， P=0.011）.Multivariate logistic analysis showed that T stage of postoperative pathology （≥T3） and Sag-H （＞5.46 cm）measured on sagittal T2-weighted images were independent risk factors for PIH （P＜0.05）. Adjusted OR values were 1.847 （95% CI 1.017-3.356） and 1.419 （95% CI 1.033-1.949）.

Conclusion

Low BMI， high T stage （≥T3） and Sag-H （＞5.46 cm） are risk factors for PIH after RARP. The results still require multi-center prospective studies for further verification in the future.

Key words: Hernia, inguinal, Prostate cancer, Robot-assisted radical prostatectomy, Magnetic resonance imaging