АNATOMICAL JUSTIFICATION OF THE ONE-STAGE RETROPUBIC PROSTATECTOMY AND SIMULTANEOUS PREPERITONEAL HERNIOPLASTY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA AND INGUINAL HERNIA

Abstract. Among the complex and unresolved issues of Urology and Herniology, simultaneous operations for benign prostatic hyperplasia and inguinal hernia occupy a significant place. The aim of the study: from the standpoint of the anatomical structure of the inguinal space and the posterior wall of the inguinal canal, to substantiate the feasibility of using a single-stage inguinal prostatectomy and simultaneous preperitoneal inguinal hernioplasty. Materials and methods. To substantiate the feasibility of retropubic and simultaneous preperitoneal hernioplasty, the distance from the middle of the vesico-prostatic junction to the middle of the opening of the direct and oblique inguinal hernias was determined during the operation after removal of the hernial sac from the right and left sides. All one-stages retropubic prostatectomies and simultaneous hernioplasty were performed through a transverse suprapubic approach, the length of which ranged from 15 to 20 cm, depending on the patient’s constitution. 58 simultaneous hernioplasty were performed in 50 patients (8 patients underwent hernioplasty on both sides): inguinal hernias were found on the right side in 38 cases, on the left side in 20. In 34 patients, the hernias were oblique, in 24 – direct. Anatomical measurements were performed in 32 patients, who underwent 36 preperitoneal hernioplasty (20 on the right side, 16 on the left). The results. The average distance from the middle of the vesico-prostatic junction to the middle of the direct hernia opening was (7.7±1.2) cm on the right side and (7.9±1.1) cm on the left; the average distance from the middle of the vesico-prostatic junction to the middle of the oblique hernia opening was (11.8±1.4) cm on the right side and (11.6±1.6) cm on the left. It has been established that the operating areas of retropubic prostatectomy and simultaneous preperitoneal inguinal hernioplasty are located side by side, and the maximum distance between them does not exceed 12 cm. A transverse suprapubic incision of up to 20 cm is sufficient to perform bilateral inguinal preperitoneal hernioplasty. Conclusions. The close location of the intraoperative prostatectomy zone to the hernioplasty zone requires simultaneous preperitoneal hernioplasty of not only obvious but also hidden (occult) inguinal hernias, as well as inguinal hernias in the initial stages of their formation when performing prostatectomy in patients with benign prostatic hyperplasia and inguinal hernia.