同時進行的經尿道前列腺切除術與腹股溝疝氣修補術

許庭偉¹、曾文歆^1,2、黃冠華¹、邱文祥³、李健逢⁴、薛佑玲⁵

¹奇美醫療財團法人奇美醫院外科部泌尿外科；²國立中山大學醫學院生物醫學研究所；

³新光醫療財團法人新光吳火獅紀念醫院泌尿部；⁴奇美醫療財團法人奇美醫院病理部；

⁵國立中山大學醫學院精準醫學研究所

Concurrent Transurethral Resection of The Prostate (TURP) and Inguinal Hernioplasty

Ting-Wei Hsu¹、Wen-Hsin Tseng^1,2、Steven K. Huang¹、Allen W. Chiu³、Chien-Feng Li⁴、 Yow-Ling Shiue⁵

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Institute of Biomedical Science, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

⁴Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan

⁵Institute of Precision Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan

Purpose:

Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males, leading to bladder outlet obstruction (BOO) and associated urinary symptoms. With increasing life expectancy, the incidence of BPH and its co-morbidities, like inguinal hernia, has risen. This study explores the efficacy of combining transurethral resection of the prostate (TURP) and inguinal hernioplasty in a single surgical session to address both conditions, potentially reducing the need for multiple hospitalizations and surgical interventions.

Materials and Methods:

This retrospective study at Chi Mei Medical Center included patients from 2014 to 2023 who underwent concurrent TURP and inguinal hernioplasty. A total of 85 patients met the criteria defined for this study. Preoperative, intraoperative, and postoperative characteristics were meticulously documented. Outcomes evaluated included the duration of the surgery, incidence of intraoperative and postoperative complications, duration of Foley catheterization and length of hospital stay. We assess the treatment efficacy by analyzing changes in voiding symptoms and alterations in urinary medications. Additionally, we conducted a comparative assessment of the surgical outcomes between two distinct techniques for inguinal hernia repair: open hernioplasty and laparoscopic hernioplasty.

Results:

In 85 patients who met the criteria, the mean age was 71.1 ± 7.8 years. The study reported no significant intraoperative complications, and postoperative care was focused on monitoring for blood loss, infection, and managing pain. The average postoperative hospital stay was 2.9 ± 1.0 days and the mean duration of catheterization was 51.6 ± 16.7 hours. A minimal complication rate was observed during the one-year follow-up, with 1 developing urinary tract infection and epididymitis two weeks after discharge, 1 developing hyponatremia two weeks after discharge, and 3 experiencing urethral stricture within a year, undergoing transurethral incision of the bladder neck (TUIBN), indicating a similar complication rate compared to previous studies. Great treatment efficacy was also noted. A significant reduction in both operative duration (open hernioplasty: 3hr 45min ± 67min and laparoscopic hernioplasty: 2hr 55min ± 45min, p=0.0011) and catheterization interval (open hernioplasty: 54.5 ± 17.9 hours and laparoscopic hernioplasty: 44.7 ± 11 hours, p=0.0492) was observed in patients undergoing laparoscopic hernioplasty as opposed to those receiving open hernioplasty.

Conclusion:

Our study results demonstrate that a concurrent TURP and inguinal hernioplasty is effective for managing BPH-induced BOO and inguinal hernia over a one-year follow-up period, with a minimal complication rate. Crucially, this approach is expected to reduce the number of hospital stays and surgical interventions, thereby lowering associated risks and costs. Moreover, within the context of combined surgery, laparoscopic techniques offer the advantage of shorter operative times and reduced durations of catheterization. Overall, combined surgery appears to be a feasible surgical option for appropriately selected patients.