Comparison Between Hernioplasty Alone and Combined with TURP: A 10-Year Single-Center Retrospective Study

Comparison Between Hernioplasty Alone and Combined with TURP: A 10-Year Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison Between Hernioplasty Alone and Combined with TURP: A 10-Year Single-Center Retrospective Study Shu-jhen Jheng, Wen-Hsin Tseng, Ting-Wei Hsu, Chien-Liang Liu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7486769/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Acute postoperative urinary retention (POUR) is a frequent complication following urologic and general surgeries, particularly in elderly male patients. Both transurethral resection of the prostate (TURP) and laparoscopic hernioplasty (LH) independently increase the risk of POUR. However, evidence regarding the incidence of POUR after simultaneous TURP and LH remains limited. Objective This study aimed to evaluate whether combined TURP and LH increase the risk of POUR compared with LH alone. Methods We retrospectively reviewed 156 patients who underwent inguinal hernia repair at a single institution between 2013 and 2024. After applying exclusion criteria, 129 patients were included for analysis. Perioperative outcomes were compared between patients undergoing simultaneous TURP with hernioplasty (n = 85) and those receiving laparoscopic hernioplasty alone (n = 44). A subgroup analysis was conducted focusing exclusively on patients who underwent laparoscopic hernioplasty, with or without TURP (TURP + LH, n = 24; LH only, n = 44). Parameters analyzed included age, operative time, Foley catheter duration, re-catheterization rate, postoperative analgesic use, and hospital stay. Statistical analysis was performed using SPSS version 30.0, with p < 0.05 considered significant. Results Patients in the combined TURP + LH group were older (70.9 ± 6.2 vs. 60.3 ± 16.4 years, p = 0.004) and had longer operative times (175 ± 45 vs. 88 ± 34 minutes, p < 0.001). Catheterization duration was also prolonged in the combined group (44.7 ± 11.0 vs. 18.5 ± 3.9 hours, p < 0.001). However, the incidence of re-catheterization (4.2% vs. 4.5%, p = 0.717) and postoperative analgesic use (21% vs. 25%, p = 0.61) did not differ significantly. The mean hospital stay was slightly longer in the TURP + LH group (2.73 ± 0.65 vs. 2.05 ± 1.14 days, p = 0.03). No major perioperative complications were observed in either group. Conclusion Although simultaneous TURP and LH were associated with longer operative times and catheterization duration, this combined approach did not significantly increase the incidence of POUR or other postoperative complications compared with LH alone. These findings suggest that concurrent TURP and LH is a safe and feasible option in appropriately selected patients, potentially reducing the need for multiple hospital admissions and anesthetic exposures. Introduction Acute postoperative urinary retention (POUR) is a common and distressing complication after various types of surgeries, particularly among elderly male patients [ 1 ]. Reported incidence rates of POUR are 5.8% in men, 2.97% in women, and 9.5% in men 65 years or older [ 2 ]. following inguinal hernia repair, influenced by factors such as age, benign prostatic hyperplasia (BPH), type of anesthesia, duration of surgery, and perioperative analgesic use [ 3 ]. POUR not only delays postoperative recovery but often necessitates additional interventions like bladder re-catheterization, increasing the risk of urinary tract infection, urethral trauma, and prolonged hospitalization [ 3 ]. Transurethral resection of the prostate (TURP) is the standard surgical treatment for moderate to severe lower urinary tract symptoms due to BPH. However, despite being a definitive treatment for bladder outlet obstruction, TURP itself carries a notable risk of acute urinary retention, particularly in the immediate postoperative period due to tissue edema, clot retention, or detrusor underactivity [ 5 , 6 , 7 , 8 ]. Simultaneously, laparoscopic hernioplasty (LH), although minimally invasive and widely adopted for inguinal hernia repair, has also been associated with increased POUR risk [ 2 ], especially in older patients with underlying voiding dysfunction. Therefore, both procedures independently present a risk for POUR. While existing studies have demonstrated that performing TURP and LH concurrently does not significantly impact overall length of hospital stay or perioperative mortality [ 9 ], it remains unclear whether performing TURP and LH concurrently amplifies the risk of POUR. A recent retrospective study by Hsu et al. [ 4 ] demonstrated the general safety of simultaneous TURP and hernioplasty; however, POUR was not the primary endpoint. Building upon their findings, the present study aims to specifically evaluate whether combined TURP and LH increases the incidence of POUR when compared to LH alone. By examining objective parameters such as catheterization duration, re-catheterization rate, operative time, postoperative analgesic use, and length of hospital stay, we aim to clarify the urologic safety profile of this combined surgical strategy. Method Study Design and Patient Selection This retrospective, single-center study reviewed male patients who underwent inguinal hernia repair from 2013 to 2024 at Chi Mei Medical Center. These patients were divided into two groups, one group accepted operation of hernioplasty combined TURP and the other group accepted hernioplasty alone. All of the patient’s ASA score was beneath 4 and exclusion criteria was applied as complicated inguinal hernias, coagulative disorders, malignant pathology finding of the prostate specimen, and other conditions that could potentially impact the evaluation. Data Collection Baseline characteristics including age, comorbidities, history of abdominal surgery, anticoagulant use, hernia classification (direct/indirect/mixed), laterality, and recurrence status were collected from medical records. Operative parameters included type of hernia repair (open vs. laparoscopic), operation time, intraoperative complications, and anesthesia method. Postoperative data included Foley catheter duration, bladder irrigation, re-catheterization, IV/IM analgesic use, hospital stay duration and discharged medication. Statistical Analysis Continuous variables were expressed as mean ± standard deviation (SD). Comparisons between two groups were performed using the Mann–Whitney U test for non-normally distributed variables and the independent-samples t-test for normally distributed variables. Categorical variables were analyzed using Fisher’s exact test. A two-tailed p value of < 0.05 was considered statistically significant. All statistical analyses were performed using SPSS Statistics version 30.0. Result During the study period, a total of 150 male patients who underwent inguinal hernia repair were initially identified. After applying exclusion criteria, which included complex or irreducible hernia (n = 1), markedly enlarged prostate volume (n = 1), elevated prostate-specific antigen (PSA) levels (n = 1), undocumented hernia classification (n = 2), and pathologically confirmed prostate malignancy (n = 16), 129 patients were deemed eligible for further analysis. These patients were categorized into two groups: 85 patients who received simultaneous transurethral resection of the prostate (TURP) and hernioplasty, and 44 patients who underwent laparoscopic hernioplasty (LH) alone. The mean age of the TURP + H group was 71.1 ± 7.8 years, while that of the LH-only group was 60.3 ± 16.4 years. Preoperative clinical characteristics are summarized in Table 1 . All included patients had an American Society of Anesthesiologists (ASA) physical status classification of II to IV. For those with a prior cancer history, the Eastern Cooperative Oncology Group (ECOG) performance status was 0. In terms of hernia classification, 37 patients had direct inguinal hernias, 66 had indirect types, and 26 presented with mixed-type hernias. Regarding laterality, 72 patients had unilateral hernias, while 57 had bilateral involvement. 15 patients had previously undergone hernia repair, including 8 with contralateral hernias and 7 with ipsilateral recurrence. Table 1 Baseline Characteristics of Patients Undergoing Hernioplasty With or Without TURP Characteristic TURP Combined Hernioplasty (n = 85) Hernioplasty Only (n = 44) Age, mean ± SD (years) 71.1 ± 7.8 60.3 ± 16.4 Comorbidities, n (%) Coronary artery disease (CAD) 9 (10.6%) 2 (4.5%) Hypertension 36 (42.4%) 13 (29.5%) Diabetes mellitus 10 (11.8%) 6 (13.6%) Asthma / COPD 5 (5.9%) 0 (0%) Chronic kidney disease (CKD) 5 (5.9%) 0 (0%) Anticoagulant use 14 (16.5%) 3 (6.8%) Abdominal surgical history 17 (20.0%) 4 (9.1%) Hernioplasty on same/contralateral side 6 / 6 1 / 2 Others 4 (4.7%) 1 (2.3%) Type of hernia, n (%) Direct 30 (35.3%) 7 (15.9%) Indirect 40 (47.1%) 26 (59.1%) Mixed 15 (17.6%) 11 (25.0%) Position of hernia Unilateral (left / right) 24 / 38 (72.9%) 6 / 4 (22.7%) Bilateral 23 (27.1%) 34 (77.3%) Status of hernia Primary / Recurrent 79 / 6 (92.9% / 7.1%) 43 / 1 (97.7% / 2.3%) Operative details are presented in Table 2 . The average operative time was notably longer in the combined TURP and hernioplasty group, averaging 3 hours and 31 minutes (± 65 minutes), compared to 1 hour and 28 minutes (± 34 minutes) in the group receiving laparoscopic hernioplasty alone. Among patients undergoing combined procedures, 61 received open hernioplasty, while 24 underwent the laparoscopic approach. In the LH-only group, 25 patients underwent conventional three-port laparoscopic hernioplasty, and 19 received single-port laparoscopic repair. Importantly, no intraoperative complications such as significant hemorrhage, major vascular injury, spermatic cord damage, or bladder perforation were reported in either group. Table 2 Operative Characteristics and Intraoperative Complications Characteristic TURP + Hernioplasty (n = 85) Hernioplasty Only (n = 44) Operation for hernia Open hernioplasty 61 0 Laparoscopic hernioplasty (3-port / 1-port) 11 / 13 25 / 19 Operation time, mean ± SD 3 h 31 min ± 65 min 1 h 28 min ± 34 min Intraoperative complications Significant hemorrhage 0 0 Major vascular injury 0 0 Spermatic cord injury 0 0 Urinary bladder injury 0 0 The mean catheterization duration was 51.6 ± 16.7 hours in the combined group and 18.5 ± 3.9 hours in the laparoscopic-only group, excluding 9 patients who required reinsertion and discharged with a catheter. Injectable analgesics were administered postoperatively in 39 patients. The mean length of hospital stay was 2.9 ± 1.0 days in the combined group and 2.05 ± 1.14 days in the laparoscopic-only group. At discharge, all patients reported VAS scores below 2, with bladder irrigation already discontinued. No postoperative fever, wound infection, or gross hematuria occurred in either group. Postoperative outcomes are presented in Table 3 . Table 3 Postoperative Parameters and Complications Characteristic TURP + Hernioplasty (n = 85) Hernioplasty Only (n = 44) Duration of Foley catheter 51.6 ± 16.7(hr) 18.5 ± 3.9(hr) Re-catheterization 7 2 Duration of hospital stay 2.9 ± 1.0 (day) 2.05 ± 1.14 (Days) Use of IV/IM form analgesics 28 11 Discharge VAS pain score < 2 (points) < 2 (points) Fever 0 0 Wound infection 0 0 Gross hematuria 0 0 Among the total 128 patients who underwent inguinal hernia repair, a subset of 68 patients who received laparoscopic hernioplasty alone or in combination with TURP were selected for comparative analysis. These patients were divided into two groups: TURP combined with laparoscopic hernioplasty (n = 24), and laparoscopic hernioplasty only (n = 44). Patients in the TURP + LH group were significantly older (70.9 ± 6.2 years vs. 60.3 ± 16.4 years; p = 0.004), and had a longer mean operation time (2 h 55 min ± 45 min vs. 1 h 28 min ± 34 min; p < 0.001). Postoperative Foley catheter duration was significantly longer in the TURP + LH group (44.7 ± 11 hours vs. 18.5 ± 3.9 hours; p < 0.001). However, the rates of re-catheterization (4.2% vs. 4.5%; p = 0.717) and IV/IM analgesic use (21% vs. 25%; p = 0.61) showed no statistically significant difference between the two groups. The mean length of hospital stay was also significantly longer in the TURP + LH group (2.73 ± 0.65 days) compared to the LH-only group (2.05 ± 1.14 days; p = 0.03). Details comparing LH combined TURP and LH only are documented in Table 4 . Table 4 Comparison of perioperative outcomes between TURP + LH and LH only Variable TURP + Laparoscopic Hernioplasty (n = 24) Laparoscopic Hernioplasty only (n = 44) p value Age (years) 70.9 ± 6.2 60.3 ± 16.4 0.004 ** Operation time(min) 2 h 55 ± 45 1 h 28 ± 34 < 0.001 ** IV/IM analgesic use, n (%) 5 (21%) 11 (25%) 0.61 Foley catheter duration (hours) 44.7 ± 11.0 18.5 ± 3.9 < 0.001 ** Re-catheterization, n (%) 1 (4.2%) 2 (4.5%) 0.717 Hospital stay (days) 2.73 ± 0.65 2.05 ± 1.14 0.030 * Discussion This study assessed the perioperative safety and the risk of POUR in patients undergoing simultaneous TURP combined with LH, compared with those undergoing LH alone. Our results showed no significant increase in POUR incidence or other major complications in the combined surgery group, indicating that this combined surgical approach is safe and feasible. Although the combined procedure resulted in longer operative times and prolonged catheterization, these factors did not translate into increased rates of re-catheterization, urinary tract infections, or wound-related complications. These findings align with previous studies [ 10 , 11 , 12 ]. Minimal intraoperative events of combined procedures was also found by Ather et al. and Patel et al. that no significant differences in complications when comparing combined procedures with single ones [ 16 , 17 ]. These studies demonstrated the safety of performing TURP alongside inguinal hernia repair without substantially increasing perioperative morbidity. Moreover, postoperative analgesic requirements and hospital length of stay were comparable between groups, suggesting that patient recovery is not adversely affected by the combined procedure. This supports the benefits of reducing anesthesia exposures and total hospitalization time, as reported in related surgical series [ 13 , 15 ]. No significant intraoperative complications such as major bleeding, bladder injury, or spermatic cord damage were observed, emphasizing the importance of surgeon experience and careful intraoperative technique. These outcomes are consistent with guidelines recommending laparoscopic hernioplasty and TURP as safe procedures when performed independently [ 5 , 14 ]. According to our previous study, combined procedures involving TURP and hernioplasty appear to pose technique-related risks rather than patient-specific hazards [ 4 ]. Previous studies had reported that laparoscopic or totally extraperitoneal approaches yield shorter operative times noted an average of 2 h 55 min (± 45 min) versus 3 h 45 min (± 67 min) for open repairs and reduced hospital stays (as little as 1.2 days for concurrent procedures compared with 4.8 days for staged operations). In contrast, these techniques correlate with higher seroma rates (ranging from 11.5–23.5%) and, when performed concurrently, elevated rates of clot retention (11.5%) [ 18 ]. Additionally, urethral stricture emerged in up to 11.7% of patients in one series [ 13 ] and was noted as three distinct cases in another [ 4 ]. No investigation provided multivariable analysis that isolated patient-level predictors, indicating that the risks of combined TURP and hernioplasty are principally linked to the choice and timing of the surgical technique [ 20 ]. This study, divided patients into two groups undergoing concurrent surgery or hernioplasty alone meticulously documenting preoperative, intraoperative, and postoperative patient conditions, provides an objective aspect to review whether the risk of POUR increase after concurrent surgery performed. However, there are still several limitations for this study. The study's external validity is constrained by its single-center design and most of the patients accepted hernioplasty alone lost followed up within one month, which indicated the potential insufficiency of follow-up duration. Additionally, the absence of a control group precludes direct statistical analysis of certain variables. Furthermore, future studies with larger sample sizes are warranted to enhance reliability and reduce the impact of borderline p-values. Since the present study primarily focused on analyzing the POUR risk of two groups, it did not address the specific techniques of TURP or the methods of laparoscopic hernioplasty. Nonetheless, these technical factors may influence clinical outcomes and should be examined in subsequent research. In conclusion, despite the increased operative complexity and catheter duration, simultaneous TURP and laparoscopic hernioplasty do not increase the risk of AUR or other perioperative complications significantly [ 19 ]. This combined approach offers a practical, safe option for patients requiring treatment for both benign prostatic hyperplasia and inguinal hernia. Conclusion This study demonstrates that simultaneous transurethral resection of the prostate (TURP) combined with laparoscopic inguinal hernioplasty is a safe and feasible surgical approach for patients with coexisting benign prostatic hyperplasia and inguinal hernia. Although combined surgery results in longer operative times and extended catheterization periods, it does not significantly increase the incidence of acute urinary retention or other perioperative complications when compared to hernioplasty alone. With proper perioperative management and surgical expertise, this combined approach can reduce patient burden by minimizing anesthesia exposures and total hospitalization time, offering an effective single-session treatment option without compromising safety or recovery. Further large-scale prospective studies are warranted to confirm these findings and optimize patient selection criteria. Declarations Author contributions JSJ wrote the manuscript and analyzed the data, TWH scrutinized and revised the manuscript, WHT and TCC collected the data and designed the article, CLL, SKH, and AWC offered the conception and study design. All authors reviewed the manuscript. All authors read and approved the final manuscript. Funding No external funding source was involved in this investigation. Data availability All data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate This study was approved by the Institutional Review Board Committee [Chimei Hospital Institutional Review Board (IRB) number 11408–003] and the Chi Mei Hospital IRB waived requirements for informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Brouwer TA, van Roon EN, Rosier PFWM, et al. Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial. Perioper Med. 2021;10:2. https://doi.org/10.1186/s13741-020-00167-z . Croghan SM, Mohan HM, Breen KJ, et al. Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study. JAMA Surg. 2023;158(8):865–73. 10.1001/jamasurg.2023.2137 . Hudak SJ, Hernandez J, Thompson IM, Morey AF. Prostate surgery and postoperative urinary retention: Risks and strategies. Rev Urol. 2015;17(2):97–104. Hsu TW, Tseng WH, Huang SK, et al. Transurethral Resection of the Prostate (TURP) and concomitant inguinal hernioplasty: a single-center experience. BMC Urol. 2024;24:188. https://doi.org/10.1186/s12894-024-01571-z . Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. European Urology. 2006;50(5):969 – 79; discussion 980. 10.1016/j.eururo.2005.12.042 . PMID: 16469429. Campobasso D, et al. Post-operative acute urinary retention after greenlight laser. Analysis of risk factors from a multicentric database. Urol J. 2021;18(6):693–8. PMID: 34346047. Kaplan S, et al. Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis. 2024;27(3):485–91. https://doi.org/10.1038/s41391-023-00741-8 . De Nunzio C, et al. Young Academic Urologists’ benign prostatic obstruction nomogram predicts clinical outcome in patients treated with transurethral resection of prostate: an Italian cohort study. Minerva Urol Nefrol. 2018;70(2):211–7. PMID: 29161806. de la Calvo CI, Izurieta B, Capone JCN, Cañas R, Ramirez R, Alcaina P, F., Reyes SF, I. Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP). Urol J. 2023;20(3):187–90. https://doi.org/10.22037/uj.v20i.7374 . González-Ojeda A, Anaya-Prado R, Fuentes-Orozco C, et al. Combined transurethral prostatectomy and mesh-based tension-free inguinal hernia repair. Hernia. 2003;7:141–5. https://doi.org/10.1007/s10029-003-0127-z . Devarajan R, Jaganathan RS, Harriss DR, Chua CB, Bishop MC. Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review. BJU Int. 1999;84(6):637–9. https://pubmed.ncbi.nlm.nih.gov/10510107/ . Javanmard B, Nazari Sabet M, Esfahanian F, Neshat S, Niri D, Mortezaei F, A. and, Hasani SH. Transurethral Resection of the Prostate and Inguinal Mesh Herniorrhaphy: Does Single Session Surgery Work Better? A Randomized Clinical Trial. Translational Res Urol. 2022;4(1):30–4. 10.22034/tru.2022.324774.1098 . Harvitkar RU, Shetty PC, Joshi A. Concurrent laparoscopic totally extraperitoneal inguinal hernia repair and transurethral resection of prostate: Breaking with convention - A retrospective study. J Minim Access Surg. 2022;18(1):72–6. https://doi.org/10.4103/jmas.JMAS_260_20 . Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403. https://doi.org/10.1007/s10029-009-0529-7 . Chiacchio G, Beltrami M, Cicconofri A, Nedbal C, Pitoni L, Fuligni D, Maggi M, Milanese G, Galosi AB, Castellani D, Giulioni C. Simultaneous Inguinal Hernia Repair with Monofilament Polypropylene Mesh during Robot-Assisted Radical Prostatectomy: Results from a Single Institute Series. Medicina. 2023;59(5):820. https://doi.org/10.3390/medicina59050820 . Ather MH, Faruqui N, Abid F, Sulaiman MN. Is there a difference in early perioperative morbidity in transurethral resection of prostate (TURP) versus TURP with cystolitholapaxy and TURP with inguinal herniorrhaphy? Int Urol Nephrol. 2002;33(1):69–72. https://doi.org/10.1023/a:1014457020723 . Patel A, Nunez R, Mmeje CO, Humphreys MR. Safety and feasibility of concomitant surgery during holmium laser enucleation of the prostate (HoLEP). World J Urol. 2014;32(6):1543–9. https://doi.org/10.1007/s00345-014-1254-0 . ElmelIgy HA, Esmat E, Rady M, Elesialy K, Elleithy T, Badawy MH. Transurethral resection of the prostate (TURP) and laparoscopic inguinal hernioplasty as combined versus separate procedures in the Era of COVID 19. Int J Health Sci. 2022;6(S9):3179–90. https://doi.org/10.53730/ijhs.v6nS9.13243 . Dahami Z, Barjani F, Saghir O, Ben Elkhaiat R, Moudouni MS, Sarf I. Cure de hernie inguinale et résection transurétrale de l'adénome de prostate en un seul temps opératoire [Combined inguinal hernia repair and transurethral resection of the prostate (TURP) for benign prostatic hypertrophy]. Journal de chirurgie. 2009;146(6):549–52. https://doi.org/10.1016/j.jchir.2009.10.005 . González-Ojeda A, Marquina M, Calva J, Mendoza A, de la Garza L. Combined inguinal herniorrhaphy and transurethral prostatectomy. Br J Surg. 1991;78(12):1443–5. https://doi.org/10.1002/bjs.1800781211 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7486769","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":533627999,"identity":"8ee94b5d-929e-4293-88eb-7501a64b0ab2","order_by":0,"name":"Shu-jhen Jheng","email":"","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Shu-jhen","middleName":"","lastName":"Jheng","suffix":""},{"id":533628001,"identity":"7d71e4b1-9b05-4979-8c41-23a157863599","order_by":1,"name":"Wen-Hsin Tseng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYNCCCgYGA6IV84DJM0haeIjSwthGihZ7Bh7Dx4XzDsubszcfYPhRsY3BXiKBkC08xsYztx023NlzLIGx58xtBh7CWni3SfNuO8y44UaOATNjG1CLNGEt23/zzjlsT5KWbcy8DYcTSdBymP+zNM+x9OQNZ44lHAT6hYfn/gP8Wtjb2xI/89RY22443nzwwY+K23LsPQfwa2FgBpPNYPIAAxHRAgN1xCocBaNgFIyCkQgAW3A+PPpokAkAAAAASUVORK5CYII=","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Wen-Hsin","middleName":"","lastName":"Tseng","suffix":""},{"id":533628003,"identity":"3649449a-caa6-4843-b3c7-3cbef88fabdf","order_by":2,"name":"Ting-Wei Hsu","email":"","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ting-Wei","middleName":"","lastName":"Hsu","suffix":""},{"id":533628006,"identity":"45357a5d-8c39-4c8a-b6a3-13e7b3ac7095","order_by":3,"name":"Chien-Liang Liu","email":"","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Chien-Liang","middleName":"","lastName":"Liu","suffix":""},{"id":533628011,"identity":"4f7da6af-3f3c-4839-8710-383048ee3068","order_by":4,"name":"Steven K. Huang","email":"","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Steven","middleName":"K.","lastName":"Huang","suffix":""},{"id":533628015,"identity":"99f4fc55-bdaf-4ff1-bd0d-8d1a6626ce13","order_by":5,"name":"Tsai-chieh Chou","email":"","orcid":"","institution":"Chi Mei Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Tsai-chieh","middleName":"","lastName":"Chou","suffix":""},{"id":533628019,"identity":"040e3ece-ec02-41f3-8649-da1a803b43dc","order_by":6,"name":"Allen W Chiu","email":"","orcid":"","institution":"Shin Kong WHS Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Allen","middleName":"W","lastName":"Chiu","suffix":""}],"badges":[],"createdAt":"2025-08-29 08:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7486769/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7486769/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94175039,"identity":"ed133da9-7cf5-4181-a370-f44b883613eb","added_by":"auto","created_at":"2025-10-23 08:14:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":38222,"visible":true,"origin":"","legend":"","description":"","filename":"ComparisonBetweenHernioplastyAloneandCombinedwithTURPrevise.docx","url":"https://assets-eu.researchsquare.com/files/rs-7486769/v1/c64d8a78d9e862782585e8a4.docx"},{"id":94175040,"identity":"2a372327-12b8-450f-afad-610298b734a2","added_by":"auto","created_at":"2025-10-23 08:14:44","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9402,"visible":true,"origin":"","legend":"","description":"","filename":"ecee00857713448eb9ef88ac8edd5ec2.json","url":"https://assets-eu.researchsquare.com/files/rs-7486769/v1/1af461c88021cc9e5ad43eb5.json"},{"id":94175043,"identity":"03911a99-0af3-4af1-9526-573c16a31373","added_by":"auto","created_at":"2025-10-23 08:14:47","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69541,"visible":true,"origin":"","legend":"","description":"","filename":"ecee00857713448eb9ef88ac8edd5ec21enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7486769/v1/f4ab4cea04219ddb2d2cb107.xml"},{"id":94175041,"identity":"b6a7b469-562d-4dd2-8b54-7da48004e776","added_by":"auto","created_at":"2025-10-23 08:14:44","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69903,"visible":true,"origin":"","legend":"","description":"","filename":"ecee00857713448eb9ef88ac8edd5ec21structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7486769/v1/9f19750c7d93cc1760985009.xml"},{"id":94175042,"identity":"7fc68615-d868-4d27-ae0e-61bcbc971af2","added_by":"auto","created_at":"2025-10-23 08:14:45","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74572,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7486769/v1/42f5b5565072ecf59672bdfe.html"},{"id":94175476,"identity":"c3418c8c-524d-4c42-a3ef-c72b00a59b93","added_by":"auto","created_at":"2025-10-23 08:22:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":571907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7486769/v1/38b14293-607e-4e81-9dee-91ba5e597c7b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison Between Hernioplasty Alone and Combined with TURP: A 10-Year Single-Center Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute postoperative urinary retention (POUR) is a common and distressing complication after various types of surgeries, particularly among elderly male patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Reported incidence rates of POUR are 5.8% in men, 2.97% in women, and 9.5% in men 65 years or older [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. following inguinal hernia repair, influenced by factors such as age, benign prostatic hyperplasia (BPH), type of anesthesia, duration of surgery, and perioperative analgesic use [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. POUR not only delays postoperative recovery but often necessitates additional interventions like bladder re-catheterization, increasing the risk of urinary tract infection, urethral trauma, and prolonged hospitalization [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTransurethral resection of the prostate (TURP) is the standard surgical treatment for moderate to severe lower urinary tract symptoms due to BPH. However, despite being a definitive treatment for bladder outlet obstruction, TURP itself carries a notable risk of acute urinary retention, particularly in the immediate postoperative period due to tissue edema, clot retention, or detrusor underactivity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Simultaneously, laparoscopic hernioplasty (LH), although minimally invasive and widely adopted for inguinal hernia repair, has also been associated with increased POUR risk [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], especially in older patients with underlying voiding dysfunction. Therefore, both procedures independently present a risk for POUR.\u003c/p\u003e\u003cp\u003eWhile existing studies have demonstrated that performing TURP and LH concurrently does not significantly impact overall length of hospital stay or perioperative mortality [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], it remains unclear whether performing TURP and LH concurrently amplifies the risk of POUR. A recent retrospective study by Hsu et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] demonstrated the general safety of simultaneous TURP and hernioplasty; however, POUR was not the primary endpoint. Building upon their findings, the present study aims to specifically evaluate whether combined TURP and LH increases the incidence of POUR when compared to LH alone. By examining objective parameters such as catheterization duration, re-catheterization rate, operative time, postoperative analgesic use, and length of hospital stay, we aim to clarify the urologic safety profile of this combined surgical strategy.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eStudy Design and Patient Selection\u003c/p\u003e\u003cp\u003eThis retrospective, single-center study reviewed male patients who underwent inguinal hernia repair from 2013 to 2024 at Chi Mei Medical Center. These patients were divided into two groups, one group accepted operation of hernioplasty combined TURP and the other group accepted hernioplasty alone. All of the patient\u0026rsquo;s ASA score was beneath 4 and exclusion criteria was applied as complicated inguinal hernias, coagulative disorders, malignant pathology finding of the prostate specimen, and other conditions that could potentially impact the evaluation.\u003c/p\u003e\u003cp\u003eData Collection\u003c/p\u003e\u003cp\u003eBaseline characteristics including age, comorbidities, history of abdominal surgery, anticoagulant use, hernia classification (direct/indirect/mixed), laterality, and recurrence status were collected from medical records. Operative parameters included type of hernia repair (open vs. laparoscopic), operation time, intraoperative complications, and anesthesia method. Postoperative data included Foley catheter duration, bladder irrigation, re-catheterization, IV/IM analgesic use, hospital stay duration and discharged medication.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Comparisons between two groups were performed using the Mann\u0026ndash;Whitney U test for non-normally distributed variables and the independent-samples t-test for normally distributed variables. Categorical variables were analyzed using Fisher\u0026rsquo;s exact test. A two-tailed p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using SPSS Statistics version 30.0.\u003c/p\u003e\u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eDuring the study period, a total of 150 male patients who underwent inguinal hernia repair were initially identified. After applying exclusion criteria, which included complex or irreducible hernia (n\u0026thinsp;=\u0026thinsp;1), markedly enlarged prostate volume (n\u0026thinsp;=\u0026thinsp;1), elevated prostate-specific antigen (PSA) levels (n\u0026thinsp;=\u0026thinsp;1), undocumented hernia classification (n\u0026thinsp;=\u0026thinsp;2), and pathologically confirmed prostate malignancy (n\u0026thinsp;=\u0026thinsp;16), 129 patients were deemed eligible for further analysis.\u003c/p\u003e\u003cp\u003eThese patients were categorized into two groups: 85 patients who received simultaneous transurethral resection of the prostate (TURP) and hernioplasty, and 44 patients who underwent laparoscopic hernioplasty (LH) alone. The mean age of the TURP\u0026thinsp;+\u0026thinsp;H group was 71.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 years, while that of the LH-only group was 60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4 years. Preoperative clinical characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All included patients had an American Society of Anesthesiologists (ASA) physical status classification of II to IV. For those with a prior cancer history, the Eastern Cooperative Oncology Group (ECOG) performance status was 0. In terms of hernia classification, 37 patients had direct inguinal hernias, 66 had indirect types, and 26 presented with mixed-type hernias. Regarding laterality, 72 patients had unilateral hernias, while 57 had bilateral involvement. 15 patients had previously undergone hernia repair, including 8 with contralateral hernias and 7 with ipsilateral recurrence.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of Patients Undergoing Hernioplasty With or Without TURP\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTURP Combined Hernioplasty (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHernioplasty Only (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eComorbidities, n (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary artery disease (CAD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (42.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (29.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsthma / COPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic kidney disease (CKD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnticoagulant use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (16.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (6.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal surgical history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHernioplasty on same/contralateral side\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 / 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 / 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eType of hernia, n (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndirect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (47.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (59.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMixed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (17.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePosition of hernia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnilateral (left / right)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 / 38 (72.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 / 4 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (27.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (77.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eStatus of hernia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary / Recurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 / 6 (92.9% / 7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 / 1 (97.7% / 2.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOperative details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The average operative time was notably longer in the combined TURP and hernioplasty group, averaging 3 hours and 31 minutes (\u0026plusmn;\u0026thinsp;65 minutes), compared to 1 hour and 28 minutes (\u0026plusmn;\u0026thinsp;34 minutes) in the group receiving laparoscopic hernioplasty alone. Among patients undergoing combined procedures, 61 received open hernioplasty, while 24 underwent the laparoscopic approach. In the LH-only group, 25 patients underwent conventional three-port laparoscopic hernioplasty, and 19 received single-port laparoscopic repair. Importantly, no intraoperative complications such as significant hemorrhage, major vascular injury, spermatic cord damage, or bladder perforation were reported in either group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOperative Characteristics and Intraoperative Complications\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTURP\u0026thinsp;+\u0026thinsp;Hernioplasty (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHernioplasty Only (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eOperation for hernia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen hernioplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaparoscopic hernioplasty (3-port / 1-port)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 / 13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 / 19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperation time, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 h 31 min\u0026thinsp;\u0026plusmn;\u0026thinsp;65 min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 h 28 min\u0026thinsp;\u0026plusmn;\u0026thinsp;34 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIntraoperative complications\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor vascular injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpermatic cord injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrinary bladder injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean catheterization duration was 51.6\u0026thinsp;\u0026plusmn;\u0026thinsp;16.7 hours in the combined group and 18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 hours in the laparoscopic-only group, excluding 9 patients who required reinsertion and discharged with a catheter. Injectable analgesics were administered postoperatively in 39 patients. The mean length of hospital stay was 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 days in the combined group and 2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 days in the laparoscopic-only group. At discharge, all patients reported VAS scores below 2, with bladder irrigation already discontinued. No postoperative fever, wound infection, or gross hematuria occurred in either group. Postoperative outcomes are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative Parameters and Complications\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTURP\u0026thinsp;+\u0026thinsp;Hernioplasty (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHernioplasty Only (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Foley catheter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.6\u0026thinsp;\u0026plusmn;\u0026thinsp;16.7(hr)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9(hr)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRe-catheterization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospital stay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 (day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 (Days)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of IV/IM form analgesics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDischarge VAS pain score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2 (points)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2 (points)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGross hematuria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong the total 128 patients who underwent inguinal hernia repair, a subset of 68 patients who received laparoscopic hernioplasty alone or in combination with TURP were selected for comparative analysis. These patients were divided into two groups: TURP combined with laparoscopic hernioplasty (n\u0026thinsp;=\u0026thinsp;24), and laparoscopic hernioplasty only (n\u0026thinsp;=\u0026thinsp;44). Patients in the TURP\u0026thinsp;+\u0026thinsp;LH group were significantly older (70.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 years vs. 60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4 years; p\u0026thinsp;=\u0026thinsp;0.004), and had a longer mean operation time (2 h 55 min\u0026thinsp;\u0026plusmn;\u0026thinsp;45 min vs. 1 h 28 min\u0026thinsp;\u0026plusmn;\u0026thinsp;34 min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Postoperative Foley catheter duration was significantly longer in the TURP\u0026thinsp;+\u0026thinsp;LH group (44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11 hours vs. 18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 hours; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the rates of re-catheterization (4.2% vs. 4.5%; p\u0026thinsp;=\u0026thinsp;0.717) and IV/IM analgesic use (21% vs. 25%; p\u0026thinsp;=\u0026thinsp;0.61) showed no statistically significant difference between the two groups. The mean length of hospital stay was also significantly longer in the TURP\u0026thinsp;+\u0026thinsp;LH group (2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65 days) compared to the LH-only group (2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 days; p\u0026thinsp;=\u0026thinsp;0.03). Details comparing LH combined TURP and LH only are documented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of perioperative outcomes between TURP\u0026thinsp;+\u0026thinsp;LH and LH only\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTURP\u0026thinsp;+\u0026thinsp;Laparoscopic Hernioplasty (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLaparoscopic Hernioplasty only (n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.004 **\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperation time(min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 h 55 \u0026plusmn; 45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 h 28 \u0026plusmn; 34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001 **\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIV/IM analgesic use, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFoley catheter duration (hours)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001 **\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRe-catheterization, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.717\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.030 *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the perioperative safety and the risk of POUR in patients undergoing simultaneous TURP combined with LH, compared with those undergoing LH alone. Our results showed no significant increase in POUR incidence or other major complications in the combined surgery group, indicating that this combined surgical approach is safe and feasible.\u003c/p\u003e\u003cp\u003eAlthough the combined procedure resulted in longer operative times and prolonged catheterization, these factors did not translate into increased rates of re-catheterization, urinary tract infections, or wound-related complications. These findings align with previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Minimal intraoperative events of combined procedures was also found by Ather et al. and Patel et al. that no significant differences in complications when comparing combined procedures with single ones [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These studies demonstrated the safety of performing TURP alongside inguinal hernia repair without substantially increasing perioperative morbidity.\u003c/p\u003e\u003cp\u003eMoreover, postoperative analgesic requirements and hospital length of stay were comparable between groups, suggesting that patient recovery is not adversely affected by the combined procedure. This supports the benefits of reducing anesthesia exposures and total hospitalization time, as reported in related surgical series [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNo significant intraoperative complications such as major bleeding, bladder injury, or spermatic cord damage were observed, emphasizing the importance of surgeon experience and careful intraoperative technique. These outcomes are consistent with guidelines recommending laparoscopic hernioplasty and TURP as safe procedures when performed independently [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to our previous study, combined procedures involving TURP and hernioplasty appear to pose technique-related risks rather than patient-specific hazards [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous studies had reported that laparoscopic or totally extraperitoneal approaches yield shorter operative times noted an average of 2 h 55 min (\u0026plusmn;\u0026thinsp;45 min) versus 3 h 45 min (\u0026plusmn;\u0026thinsp;67 min) for open repairs and reduced hospital stays (as little as 1.2 days for concurrent procedures compared with 4.8 days for staged operations). In contrast, these techniques correlate with higher seroma rates (ranging from 11.5\u0026ndash;23.5%) and, when performed concurrently, elevated rates of clot retention (11.5%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, urethral stricture emerged in up to 11.7% of patients in one series [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and was noted as three distinct cases in another [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. No investigation provided multivariable analysis that isolated patient-level predictors, indicating that the risks of combined TURP and hernioplasty are principally linked to the choice and timing of the surgical technique [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study, divided patients into two groups undergoing concurrent surgery or hernioplasty alone meticulously documenting preoperative, intraoperative, and postoperative patient conditions, provides an objective aspect to review whether the risk of POUR increase after concurrent surgery performed. However, there are still several limitations for this study. The study's external validity is constrained by its single-center design and most of the patients accepted hernioplasty alone lost followed up within one month, which indicated the potential insufficiency of follow-up duration. Additionally, the absence of a control group precludes direct statistical analysis of certain variables. Furthermore, future studies with larger sample sizes are warranted to enhance reliability and reduce the impact of borderline p-values. Since the present study primarily focused on analyzing the POUR risk of two groups, it did not address the specific techniques of TURP or the methods of laparoscopic hernioplasty. Nonetheless, these technical factors may influence clinical outcomes and should be examined in subsequent research.\u003c/p\u003e\u003cp\u003eIn conclusion, despite the increased operative complexity and catheter duration, simultaneous TURP and laparoscopic hernioplasty do not increase the risk of AUR or other perioperative complications significantly [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This combined approach offers a practical, safe option for patients requiring treatment for both benign prostatic hyperplasia and inguinal hernia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that simultaneous transurethral resection of the prostate (TURP) combined with laparoscopic inguinal hernioplasty is a safe and feasible surgical approach for patients with coexisting benign prostatic hyperplasia and inguinal hernia. Although combined surgery results in longer operative times and extended catheterization periods, it does not significantly increase the incidence of acute urinary retention or other perioperative complications when compared to hernioplasty alone. With proper perioperative management and surgical expertise, this combined approach can reduce patient burden by minimizing anesthesia exposures and total hospitalization time, offering an effective single-session treatment option without compromising safety or recovery. Further large-scale prospective studies are warranted to confirm these findings and optimize patient selection criteria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJSJ wrote the manuscript and analyzed the data, TWH scrutinized and revised the manuscript, WHT and TCC collected the data and designed the article, CLL, SKH, and AWC offered the conception and study design. All authors reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding source was involved in this investigation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board Committee [Chimei Hospital Institutional Review Board (IRB) number 11408\u0026ndash;003] and the Chi Mei Hospital IRB waived requirements for informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrouwer TA, van Roon EN, Rosier PFWM, et al. Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial. Perioper Med. 2021;10:2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13741-020-00167-z\u003c/span\u003e\u003cspan address=\"10.1186/s13741-020-00167-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCroghan SM, Mohan HM, Breen KJ, et al. Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study. JAMA Surg. 2023;158(8):865\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamasurg.2023.2137\u003c/span\u003e\u003cspan address=\"10.1001/jamasurg.2023.2137\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHudak SJ, Hernandez J, Thompson IM, Morey AF. Prostate surgery and postoperative urinary retention: Risks and strategies. Rev Urol. 2015;17(2):97\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHsu TW, Tseng WH, Huang SK, et al. Transurethral Resection of the Prostate (TURP) and concomitant inguinal hernioplasty: a single-center experience. BMC Urol. 2024;24:188. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12894-024-01571-z\u003c/span\u003e\u003cspan address=\"10.1186/s12894-024-01571-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. European Urology. 2006;50(5):969\u0026thinsp;\u0026ndash;\u0026thinsp;79; discussion 980. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eururo.2005.12.042\u003c/span\u003e\u003cspan address=\"10.1016/j.eururo.2005.12.042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 16469429.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampobasso D, et al. Post-operative acute urinary retention after greenlight laser. Analysis of risk factors from a multicentric database. Urol J. 2021;18(6):693\u0026ndash;8. PMID: 34346047.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaplan S, et al. Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis. 2024;27(3):485\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41391-023-00741-8\u003c/span\u003e\u003cspan address=\"10.1038/s41391-023-00741-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Nunzio C, et al. Young Academic Urologists\u0026rsquo; benign prostatic obstruction nomogram predicts clinical outcome in patients treated with transurethral resection of prostate: an Italian cohort study. Minerva Urol Nefrol. 2018;70(2):211\u0026ndash;7. PMID: 29161806.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede la Calvo CI, Izurieta B, Capone JCN, Ca\u0026ntilde;as R, Ramirez R, Alcaina P, F., Reyes SF, I. Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP). Urol J. 2023;20(3):187\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.22037/uj.v20i.7374\u003c/span\u003e\u003cspan address=\"10.22037/uj.v20i.7374\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Ojeda A, Anaya-Prado R, Fuentes-Orozco C, et al. Combined transurethral prostatectomy and mesh-based tension-free inguinal hernia repair. Hernia. 2003;7:141\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10029-003-0127-z\u003c/span\u003e\u003cspan address=\"10.1007/s10029-003-0127-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDevarajan R, Jaganathan RS, Harriss DR, Chua CB, Bishop MC. Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review. BJU Int. 1999;84(6):637\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/10510107/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/10510107/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJavanmard B, Nazari Sabet M, Esfahanian F, Neshat S, Niri D, Mortezaei F, A. and, Hasani SH. Transurethral Resection of the Prostate and Inguinal Mesh Herniorrhaphy: Does Single Session Surgery Work Better? A Randomized Clinical Trial. Translational Res Urol. 2022;4(1):30\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22034/tru.2022.324774.1098\u003c/span\u003e\u003cspan address=\"10.22034/tru.2022.324774.1098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarvitkar RU, Shetty PC, Joshi A. Concurrent laparoscopic totally extraperitoneal inguinal hernia repair and transurethral resection of prostate: Breaking with convention - A retrospective study. J Minim Access Surg. 2022;18(1):72\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/jmas.JMAS_260_20\u003c/span\u003e\u003cspan address=\"10.4103/jmas.JMAS_260_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSimons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343\u0026ndash;403. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10029-009-0529-7\u003c/span\u003e\u003cspan address=\"10.1007/s10029-009-0529-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChiacchio G, Beltrami M, Cicconofri A, Nedbal C, Pitoni L, Fuligni D, Maggi M, Milanese G, Galosi AB, Castellani D, Giulioni C. Simultaneous Inguinal Hernia Repair with Monofilament Polypropylene Mesh during Robot-Assisted Radical Prostatectomy: Results from a Single Institute Series. Medicina. 2023;59(5):820. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina59050820\u003c/span\u003e\u003cspan address=\"10.3390/medicina59050820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAther MH, Faruqui N, Abid F, Sulaiman MN. Is there a difference in early perioperative morbidity in transurethral resection of prostate (TURP) versus TURP with cystolitholapaxy and TURP with inguinal herniorrhaphy? Int Urol Nephrol. 2002;33(1):69\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1023/a:1014457020723\u003c/span\u003e\u003cspan address=\"10.1023/a:1014457020723\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel A, Nunez R, Mmeje CO, Humphreys MR. Safety and feasibility of concomitant surgery during holmium laser enucleation of the prostate (HoLEP). World J Urol. 2014;32(6):1543\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00345-014-1254-0\u003c/span\u003e\u003cspan address=\"10.1007/s00345-014-1254-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElmelIgy HA, Esmat E, Rady M, Elesialy K, Elleithy T, Badawy MH. Transurethral resection of the prostate (TURP) and laparoscopic inguinal hernioplasty as combined versus separate procedures in the Era of COVID 19. Int J Health Sci. 2022;6(S9):3179\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.53730/ijhs.v6nS9.13243\u003c/span\u003e\u003cspan address=\"10.53730/ijhs.v6nS9.13243\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDahami Z, Barjani F, Saghir O, Ben Elkhaiat R, Moudouni MS, Sarf I. Cure de hernie inguinale et r\u0026eacute;section transur\u0026eacute;trale de l'ad\u0026eacute;nome de prostate en un seul temps op\u0026eacute;ratoire [Combined inguinal hernia repair and transurethral resection of the prostate (TURP) for benign prostatic hypertrophy]. Journal de chirurgie. 2009;146(6):549\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jchir.2009.10.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jchir.2009.10.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Ojeda A, Marquina M, Calva J, Mendoza A, de la Garza L. Combined inguinal herniorrhaphy and transurethral prostatectomy. Br J Surg. 1991;78(12):1443\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/bjs.1800781211\u003c/span\u003e\u003cspan address=\"10.1002/bjs.1800781211\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7486769/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7486769/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAcute postoperative urinary retention (POUR) is a frequent complication following urologic and general surgeries, particularly in elderly male patients. Both transurethral resection of the prostate (TURP) and laparoscopic hernioplasty (LH) independently increase the risk of POUR. However, evidence regarding the incidence of POUR after simultaneous TURP and LH remains limited.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to evaluate whether combined TURP and LH increase the risk of POUR compared with LH alone.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe retrospectively reviewed 156 patients who underwent inguinal hernia repair at a single institution between 2013 and 2024. After applying exclusion criteria, 129 patients were included for analysis. Perioperative outcomes were compared between patients undergoing simultaneous TURP with hernioplasty (n\u0026thinsp;=\u0026thinsp;85) and those receiving laparoscopic hernioplasty alone (n\u0026thinsp;=\u0026thinsp;44). A subgroup analysis was conducted focusing exclusively on patients who underwent laparoscopic hernioplasty, with or without TURP (TURP\u0026thinsp;+\u0026thinsp;LH, n\u0026thinsp;=\u0026thinsp;24; LH only, n\u0026thinsp;=\u0026thinsp;44). Parameters analyzed included age, operative time, Foley catheter duration, re-catheterization rate, postoperative analgesic use, and hospital stay. Statistical analysis was performed using SPSS version 30.0, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePatients in the combined TURP\u0026thinsp;+\u0026thinsp;LH group were older (70.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 vs. 60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4 years, p\u0026thinsp;=\u0026thinsp;0.004) and had longer operative times (175\u0026thinsp;\u0026plusmn;\u0026thinsp;45 vs. 88\u0026thinsp;\u0026plusmn;\u0026thinsp;34 minutes, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Catheterization duration was also prolonged in the combined group (44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0 vs. 18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 hours, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the incidence of re-catheterization (4.2% vs. 4.5%, p\u0026thinsp;=\u0026thinsp;0.717) and postoperative analgesic use (21% vs. 25%, p\u0026thinsp;=\u0026thinsp;0.61) did not differ significantly. The mean hospital stay was slightly longer in the TURP\u0026thinsp;+\u0026thinsp;LH group (2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65 vs. 2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 days, p\u0026thinsp;=\u0026thinsp;0.03). No major perioperative complications were observed in either group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAlthough simultaneous TURP and LH were associated with longer operative times and catheterization duration, this combined approach did not significantly increase the incidence of POUR or other postoperative complications compared with LH alone. These findings suggest that concurrent TURP and LH is a safe and feasible option in appropriately selected patients, potentially reducing the need for multiple hospital admissions and anesthetic exposures.\u003c/p\u003e","manuscriptTitle":"Comparison Between Hernioplasty Alone and Combined with TURP: A 10-Year Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 08:14:40","doi":"10.21203/rs.3.rs-7486769/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-26T05:04:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-25T19:17:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T13:44:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259553528495345733579646852144504055568","date":"2025-10-17T10:32:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272673873667891243743893670803383556717","date":"2025-10-17T01:29:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54974294601343576790102563662555481225","date":"2025-10-15T04:14:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T15:08:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"165171046468215857960087960284696359754","date":"2025-10-10T07:52:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229059611876228144087573645519139793452","date":"2025-10-09T16:12:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T15:45:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-12T21:38:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-10T15:04:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T15:02:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-08-29T08:49:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cfa9c466-6c72-49d0-806c-9ac95d1bcdfd","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T08:14:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 08:14:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7486769","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7486769","identity":"rs-7486769","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}