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Inguinal hernia & prostate problems – priority of care?
I have a bilateral inguinal hernia, left side is small and not bothersome but the right side is larger and I experience pain in my right testical about 15-20% of the time. Im in very good health so was leaning towards having a pure tissue repair done by Dr. William Brown despite I’m on the east coast and travelling alone will be a nightmare. I figured being in good health with low bodyfat and Dr Brown has not retired yet, it may be a great time. So just as I was getting ready to start scheduling, I found some comments from Dr. Towfigh that threw a huge wrench into the equation. There is a clear warning that is someone had prostate issues they would want that to be addressed before moving forward with a hernia repair.
So I have not ever been to a urologist but over the past 5 years have come to believe I have an enlarged prostate.
I’ve came to this theory because I urinate approximately every hour or less, go at least 3-4 times in the night and have sudden urgency a lot. Interesting, for the past 5 years my blood work has identified 2 concerns with poor functioning kidneys and liver being I have extremely high ALT and BUN levels. I never did anything about it because I had no pain, just frustrating having to urinate so much. My diet is as good as it gets. But now reading if someone has a problematic prostate to tend to that first, I am back at square one with getting the hernia repair. I’ve read enlarged prostates can cause kidney damage and result in elevated blood tests.
1. What if I go to the urologist and a prostate surgery is needed, how long do I need to wait between that surgery and the pure tissue repair hernia surgery?
2. Will having a prostate surgery first cause scar tissue or compromise my chances of success with a pure tissue hernia repair?
3. Say I move forward with the pure tissue hernia repair first and it is successful, will a prostate surgery compromise that hernia repair?
4. In general, how long does someone need to wait before these 2 surgeries to have the best chances for long-term success of each?
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5 Replies
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Dr Towfigh,
Your response was beyond helpful. You deserve a reminder…spending a minute to reply to someone’s concerns can help them obtain new insight and help them pursue such a more informed course of direction.. ultimately changing their life for the BETTER!
I have pumped the brakes on the hernia surgery. I see the light with needing to fix the prostate issues first. Then getting back to the hernia repair.
You mentioned the majority of people being able to manage prostate health using medications but do you feel this approach would be less effective compared to prostate surgery if my number 1 goal is the hernia not to recurr? What I mean by that is basically I have 2 options for the prostate/BPH, treatment with medications or surgery. I lean to surgery because my rationale is I don’t want the risk of the prostate problems to come back down the road after I had a hernia surgery and risk jeapordizing that. To me there seems to be a higher risk of prostate issues coming back on a medication. Not only may it take a lot longer finding a medication that actually works but if it begins working less effectively over time then you may be in a bad position considering by that time I had the hernia surgery and it begins to compromise that hernia repair. Versus, having the prostate surgery I think there is a less chance for it to begin to get bad again and less chance to damage that hernia repair.
You mentioned 98% prostate surgery is done robotically and there is little or no issue if “you have had” a mesh or tissue based hernia repair. In those cases someone has “not had” a hernia surgery and they are going to have the prostate surgery done first, what type of prostate surgery is most effective at giving the highest chance of soft tissue hernia repair success? In other words, I’m looking for what type of prostate surgery is best to maximize my chances for a pure tissue repair. Concerned certain types of prostate surgery will hurt my chances to a pure tissue repair or does it not matter in a case your doing the prostate surgery first? Is there an optimal time someone waits after the prostate surgery before moving to have the pure tissue repair done? I ask this because I understand many people tend to see how “soon” they can have the hernia repair done but the real concern should be not how soon but how long is best to wait to get the best chances for hernia repair long term success?
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Whoa, if you are urinating hourly, that prostate needs to be addressed. An enlarged prostate must be addressed prior to any hernia repair because:
– straining due to an enlarged prostate will exacerbate a hernia
– straining due to an enlarged prostate will make a hernia repair (any technique) recur–that is not a good outcome
– an enlarged prostate will place you at high risk for urinary retention after hernia surgery, meaning you will have to have a urinary catheter placed in you and all the downstream effects of that proceddure.Most patients need only medication to control their prostatism (symptoms related to the prostate).
Most prostate surgery is done for cancer reasons. About 98% are done robotically in the US. With the robotic approach, there is little to no issue if you have had a mesh or tissue-based hernia, whether laparoscopic or open.
After robotic prostate surgery, laparoscopic hernia repair is slightly more risky. -
It’s my understanding that with robotic surgery, having mesh no longer presents a major issue for surgeons. That’s just to address the question of whether or not you can have prostate surgery if you’ve had a mesh repair. It used to apparently present a real challenge.
Also, I’ll add that I’ve had two surgeons tell me that if you have any issue with laparoscopic mesh surgery, and for example need it removed, you can still have an open tissue repair later without issue.
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I talked to a urologist when I was having mesh problems (because the “system” says that mesh does not cause urological problems therefore only urologists can consider them. Even though urologists know little about hernia repair with mesh) and he made the comment that they often had to cut through or work around the mesh when they did prostate surgery. I got the impression that it was a problem for them, that they just had to deal with.
Dr. Towfigh is well aware of all of the different methods of hernia repair, but does still use mesh for repair often. That is probably why she was aware of the problems with mesh and prostate surgery.
Of course, the obvious solution is to avoid mesh. If a “pure tissue” repair fails mesh can always be used later. The reverse is not true.
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I asked this on the other thread as well… Do the doctors believe a mesh repair would be better if one has an enlarged prostate or strains to urinate?
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