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Annals of Clinical Case Reports

2018 | Volume 3 | Article 15431

IntroductionInguinal hernia and Stress Urinary Incontinence (SUI) are well-known complications of radical

prostatectomy [1,2]. However, SUI development following inguinal herniorrhaphy is extremely rare. We report the case of a patient who developed SUI following inguinal herniorrhaphy after open radical prostatectomy. To the best of our knowledge, this is the first reported case of SUI development following inguinal herniorrhaphy in a man who had undergone radical prostatectomy.

Case PresentationA 66-year-old man was diagnosed with localized prostate cancer cT2cN0M0. His past medical

history was unremarkable. He underwent open radical prostatectomy in 2008 after a 9-month neoadjuvant hormone therapy. Following the prostatectomy, he developed mild SUI that gradually improved. Thereafter, he did not need a pad after 15 months of prostatectomy. Four years later, he underwent salvage radiation therapy (66 Gy) for biochemical recurrence. Subsequently, the prostate-specific antigenserum levels decreased from 0.64 ng/mL to 0.1 ng/mL. After radiation, he did not experience the difficulty in voiding and his Qmax was 21.0 ml/second and urinary incontinence did not develop. During the follow-up period, he developed left inguinal hernia, for which he underwent synthetic mesh repair (inguinal herniorrhaphy) in 2014. After removal of the urethral catheter 12 French in size, he developed severe SUI. He then needed more than three pads a day for his total incontinence while standing. Cystourethrography and cystourethroscopy detected only a mild urethral stricture, and a urodynamic study showed no detrusor over activity. Conservative therapies along with pelvic exercise and use of several agents, such as anticholinergics and β2-stimulants, were ineffective in treating SUI. Two year later, an artificial urinary sphincter implantation was performed, and SUI disappeared. Patient’s clinical course is shown in Figure 1.

DiscussionThe patient had moderate SUI for a few months after prostatectomy. Thereafter, SUI improved

gradually, and he rarely needed pads. SUI recurred after inguinal herniorrhaphy. Imaging as well as endoscopic and urodynamic studies were negative for urinary in continence. The underlying mechanisms for SUI recurrence after inguinal herniorrhaphy were unclear. Radiation to the prostatic fossa might have slightly affected the urethral sphincter; however, this was not the main cause for the development of SUI because he did not develop SUI after radiation therapy. It may be suspected that this patient with post-operative sphincter damage had developed urethral stenosis according to radical prostatectomy and/or post-operative radiation therapy which contributed

Stress Urinary Incontinence Following Inguinal Herniorrhaphy after Radical Prostatectomy

OPEN ACCESS

*Correspondence:Yujiro Nagata, Department of Urology,

University of Occupational and Environmental Health, Kitakyushu,

Japan,E-mail: yujiro-nagata@med.uoeh-u.

ac.jpReceived Date: 29 May 2018Accepted Date: 01 Sep 2018

Published Date: 10 Sep 2018

Citation: Nagata Y, Fukuda A, Nishii H, Takei M,

Fujimoto N. Stress Urinary Incontinence Following Inguinal Herniorrhaphy after Radical Prostatectomy. Ann Clin Case

Rep. 2018; 3: 1543.ISSN: 2474-1655

Copyright © 2018 Yujiro Nagata. This is an open access article distributed

under the Creative Commons Attribution License, which permits unrestricted

use, distribution, and reproduction in any medium, provided the original work

is properly cited.

Case ReportPublished: 10 Sep, 2018

AbstractCase: A 66-year-old man underwent open radical prostatectomy and subsequently developed left inguinal hernia. Herniorrhaphy was performed, following which he complained of severe Stress Urinary Incontinence (SUI). To the best of our knowledge, this is the first reported case of SUI development following inguinal herniorrhaphy in a man who had undergone radical prostatectomy.

Outcome: SUI was successfully treated with artificial urethral sphincter implantation

Conclusion: We should be aware of this extremely rare, but possible, complication of inguinal herniorrhaphy in a patient who has undergone radical prostatectomy.

Keywords: Urinary Incontinence; Inguinal Herniorrhaphy; Radical Prostatectomy

Yujiro Nagata1*, Atsushi Fukuda1, Hisae Nishii2, Mineo Takei3 and Naohiro Fujimoto1

1Department of Urology, University of Occupational and Environmental Health, Japan

2Department of Urology, National Center for Geriatrics and Gerontology, Japan

3Department of Urology, Harasanshin Hospital, Japan

Yujiro Nagata, et al., Annals of Clinical Case Reports - Urology

Remedy Publications LLC., | http://anncaserep.com/ 2018 | Volume 3 | Article 15432

to improvement of urinary incontinence. However, placement of urethral catheter during surgery for inguinal hernia dilated the

Figure 1: Clinical course and urinary incontinence after prostatectomy. SUI: Stress Urinary Incontinence, PRx: Prostatectomy, EBRT: External Beam Radiation Therapy.

Figure 2: The putative mechanism of SUI recurrence after inguinal herniorrhaphy. (a) Abdominal pressure to the bladder might be reduced by the dilated inguinal canal. (b) Abdominal pressure to the inguinal canal was blocked by the inguinal herniorrhaphy, resulting in SUI due to increased abdominal pressure to the bladder.

stenosis, and after removal manifested stress urinary incontinence which had been once hidden by the urethral stenosis. This story is, however, unlikely, because of the following reasons; 1) his SUI after prostatectomy disappeared 15 months surgery and he did not need a pad even after radiation, 2) he did not have the difficulty of voiding suggesting urethral stricture that could mask SUI, 3) it is hard to dilate urethral stricture with 12 French urethral catheter. Thus, we believe that herniorrhaphy was the main cause of SUI.

Abdominal pressure to the bladder might have been reduced by the dilated inguinal canal before inguinal hernia repair. However, after the herniorrhaphy, the abdominal pressure to the inguinal canal was blocked, resulting in increased abdominal pressure to the bladder; this in turn might be the main cause of SUI recurrence after the herniorrhaphy (Figure 2). To the best of our knowledge, this is the first reported case of SUI development following inguinal herniorrhaphy in a man who had undergone radical prostatectomy. Although rare in occurrence, we need to be aware of SUI after hernia repair in patients with a weak or damaged urethral sphincter.

References1. Regan TC, Mordkin RM, Constantinople NL, Spence IJ, Dejter SW Jr.

Incidence of inguinal hernias following radical retropubic prostatectomy. Urology. 1996;47(4):536-7.

2. Zhu S, Zhang H, Xie L, Chen J, Niu Y. Risk factors and prevention of inguinal hernia after radical prostatectomy: A systematic review and meta-analysis. J Urol. 2013;189(3):884-90.