Association Between Prior Inguinal Hernia Repair and Early Continence Recovery After Robot-Assisted Radical Prostatectomy.

Abstract

Objective: Early post-prostatectomy incontinence (PPI) remains a common concern after robot-assisted radical prostatectomy (RARP). Recovery patterns vary among individuals, and identifying patients at risk of delayed recovery is clinically important. We evaluated whether prior adult inguinal hernia (IH) repair is associated with early continence outcomes after RARP.

Methods: We retrospectively analyzed 305 consecutive patients who underwent RARP between 2021 and 2024. Continence was defined as pad-free status, and PPI as use of > 1 pad/day. Continence was assessed at 1 week and at 1, 3, and 6 months postoperatively. Multivariable logistic regression and generalized estimating equation (GEE) modeling were used to evaluate associations, adjusting for age and BMI. Kaplan-Meier and interval-censored Cox models were applied to assess time to continence.

Results: Twenty-seven patients (8.9%) had prior IH repair. These patients demonstrated significantly higher rates of PPI at all assessed time points. After adjustment for age and BMI, prior IH repair remained significantly associated with PPI (adjusted ORs 2.99-5.84, all p < 0.05). Longitudinal GEE analysis also suggested a slower recovery pattern in the IH group (adjusted OR 4.05, 95% CI 1.62-10.11, p = 0.003). Kaplan-Meier analysis demonstrated delayed return to continence (log-rank p < 0.001), and interval-censored Cox regression confirmed a significantly lower probability of continence recovery in this group (p = 0.001).

Conclusions: Prior IH repair was associated with delayed early continence recovery within 6 months after RARP. Given the limited IH sample and follow-up duration, these findings should be interpreted cautiously as exploratory and hypothesis-generating. Larger prospective studies with longer follow-up are warranted.