Preoperative CT findings of subclinical hernia can predict for postoperative inguinal hernia following robot-assisted laparoscopic radical prostatectomy

Purpose: To evaluate preoperative CT features that predict the development of postoperative inguinal hernia after robot-assisted laparoscopic radical prostatectomy (RALRP). Methods: We enrolled 160 men who underwent CT, subsequent RALRP, and at least three years of follow-up. CT was retrospectively reviewed in consensus by two radiologists for the presence of asymmetric spermatic cord fat and scrotal fluid collection. The diagnostic power of each CT feature for the development of postoperative inguinal hernia was calculated. Multiple logistic regression was performed to evaluate the association between CT features, clinical variables, and postoperative inguinal hernia. Results: Surgically confirmed postoperative inguinal hernia developed in 17 patients. Asymmetric spermatic cord fat was demonstrated in 13 patients, and scrotal fluid collection was seen in 59 patients. The diagnostic values of asymmetric spermatic cord fat and scrotal fluid collection for postoperative inguinal hernia were 58.8% and 88.2% sensitivity, 97.9% and 69.2% specificity, 76.9% and 25.4% positive predictive value, 95.2% and 98.0% negative predictive value, and 93.8% and 71.3% accuracy, respectively. On multiple logistic regression analysis, asymmetric spermatic cord fat, scrotal fluid collection, and low BMI were significant predictive factors for the development of postoperative inguinal hernia (odds ratios: 135.8, 31.6, and 0.7, respectively). Conclusion: The presence of asymmetric spermatic cord fat or scrotal fluid collection was significantly associated with the development of postoperative inguinal hernia.