JCU - January 2022 - 37

Talebpour et al.
37
prostatectomies. In Freyer's prostatectomy the prostatic
fossa is packed after the enucleation of the gland for
hemostatic purpose, and the pack and suprapubic drain
are brought out laterally. Actually, in this method, after
making the bladder full with normal saline via a urethral
catheter, a suprapubic midline incision is taken and the
abdomen opened in layers. The bladder is opened with a
stab knife. The prostate is then supported with a finger
passed rectally, and enucleation of prostate is undertaken.
After enucleation of the prostate, in addition to the index
finger the middle finger is inserted and the rectum is
pulled caudally; this helps to exert minimal pressure over
the venous plexus.
In the retropubic Millin's prostatectomy, the patient is
placed on the operating room table in the supine position
in mild Trendelenburg. This procedure involves removing
part of the prostate using a trans-capsular retropubic
approach (extraperitoneal), through a cut in the abdomen.
Simple prostatectomy is usually suggested for older men
with either a cancerous or a giant, non-cancerous, enlarged
prostate.10 Candidate patients for prostatectomy normally
present with the additional problem of an inguinal hernia,
and we are presenting a novel surgical method to carry out
prostatectomy and inguinal hernia repair simultaneously,
dependent on retroperitoneal insertion of mesh.
Patients and methods
Some 230 patients were referred to Sina Hospital from
2016 to 2019 as candidates for a simple prostatectomy.
The research work has been reported in line with the preferred
reporting of CasE series in surgery (PROCESS) criteria.11
The written informed consent was obtained from
all patients before surgery and the privacy rights of human
subjects were completely observed. Amongst these
patients, 19 patients with concomitant inguinal hernia
repair were selected to undergo the novel surgical method
of simultaneous simple prostatectomy and inguinal hernia
repair by retroperitoneal insertion of mesh (monofilament
polypropylene mesh 6 × 11 cm Covidien #PPM1106X3)
and single-incision surgery. Demographic characteristics
and medical records were documented prospectively
including age, body mass index (BMI), right sided/left
sided or bilateral inguinal hernia, sepsis, embolus, infection
after surgery, days of hospital admission after surgery,
recurrence of inguinal hernia within three years of follow
up, duration of surgery and direct/indirect inguinal hernia
(Table 1).
For the surgical procedure the patients were placed
supine, and either Freyer's or Millin's prostatectomy was
chosen. After bladder catheterization was done, a median
longitudinal cut was made. Simple prostatectomy was performed
and then the hernia sac recognized. At first, we
selected a polypropylene mesh (6 × 11 cm), making a hole
in the middle of it and cutting the middle of one side to the
Table 1. Demographic characteristics and medical records of our 19 cases of simultaneous prostatectomy and inguinal hernia repair.
Patients code
Age (years)
1
Body mass index
Right sided
Left sided
Bilateral
Sepsis
Embolus
Infection after surgery
Death
Hospital admission (days)
Hernia recurrence
Duration of surgery (minutes)
Type of surgery ( Millin or Fereyer)
Direct/Indirect hernia
60
26


No
No
No
No
3
No
54
M
D
No
No
No
No
4
No
102
M
D
2
62
32






3
61
28
4
65
30
5
55
28
6
68
32
7
92
38

8
57
42

9
74
32

10
83
30

11
75
28

12
61
30

13
55
32


No No No No No No No No No No No No No
No No No No No No No No No No No No No
No No No No No No No No No No No No No
No No No No No No No No No No No No No
2
4
60
2
77
5
58
2
M
I
F
D
M
I
M
D
91
M
D
3
72
F
D
4
65
6
F
I
58
M
I
5
74
M
D
3
63
M
D
2
68
M
D
5
98
No
No
No
No
2
No No No No No No No No No No No No No
80
F
I
M
I
102
3
No
110
M
D
No
No
No
No
6
No
120
M
D
No
No
No
No
5
No
110
F
D
No
No
No
No
3
No
65
M
D
14
65
30

15
59
26
16
60
22


17
65
40


18
62
42


19
63
22


JCU - January 2022

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