This study aimed to determine if there is a correlation between the presence of inguinal hernias (IH) and the severity of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The study divided 50 patients into two groups: Group A with 25 patients with IH and BPH, and Group B with 25 patients with only BPH. The groups were compared based on IPSS scores, post-void residual volumes, and prostate sizes. The results showed that Group A had significantly higher IPSS scores and post-void residuals than Group B, indicating more severe LUTS. However, prostate size did not correlate with IPSS scores or hernia presence. The study

1. Correlation between the
Inguinal Hernias and
Prostate Size Dr. Prajwal RK
Department of General Surgery

2. INTRODUCTION
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• Lower urinary tract symptoms (LUTS) are prevalent among
elderly men.
• Initial development of microscopic BPH begins as early as 25 – 30
years.
• Histologic benign prostatic hyperplasia (BPH) develops also with
advancing age.

3. INTRODUCTION
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• After the age of 45 the prevalence of BPH increases rapidly,
reaching 90% at the age of 90.
• Multiple etiologic factors have been described with the genesis of
urinary symptoms, including the effect of aging on the nervous
system and bladder, metabolic derangements, changes in fluid
regulation, obstruction and autonomic overactivity.

4. INTRODUCTION
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• LUTS can be due to mechanical obstruction to urine flow or due to
bladder hypocontraction
• The incidence of inguinal hernias (IH) also increases with age,
Various factors contribute to the development of IH, including
obesity and work-related physical activity.

5. 5
• The American Urological Association guideline, for BPH,
updated in 2006, recommends prostate surgery as first
option just for patients presenting refractory retention,
gross hematuria, bladder stones, recurrent urinary tract
infection and renal insufficiency, all clearly related to
BPH.
• No recommendations are made in men with concomitant
evidence of IH and bothersome LUTS related to BPH.

6. NEED FOR STUDY
WHY?

7. “This study was done to
determine whether
BPH is a significant
cause factor on
formation of inguinal
hernia in elderly
patients.
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8. AIMS AND OBJECTIVES
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9. Aim of
this study
The aim of this study is to verify the
correlation between the presence of IH
and the intensity of LUTS, related to
BPH, quantified through the IPSS.
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10. MATERIALS AND METHODS
▸ Source of data- all patients admitted for treatment of BPH
in general surgery and urology department over age of
45years in Tertiary care hospital, Bangalore.
▸ Total number of cases- 50
▸ Duration of study- six months(Jan 2019- Jun 2019)
▸ STUDY TYPE- Cross-sectional comparative study
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11. Methodology
▸ The study subjects were divided into two equal groups as
Group A
composed of 25
patients with IH
with BPH.
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Group B
composed of 25
patients with BPH
without IH.

12. Inclusion & Exclusion criteria
▸ All patients admitted with
LUTS above 45 years of age
with BPH and Inguinal
hernias (Group A) and LUTS
with BPH without Inguinal
Hernia (Group B) were
included in the study.
▸ Presence urinary tract
infection, urethral stricture,
prostate cancer, a past history
of abdominal surgery, previous
therapy for voiding dysfunction
during the last 3 months, or
taking medications that could
affect the lower urinary tract.
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13. Study design
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14. Study design
▸ IPSS, POST VOID RESIDUAL VOLUME AND
PROSTATE VOLUME WERE ASSESSED .
▸ THESE WERE COMPARED BETWEEN TWO
GROUPS.
GROUP A GROUP B

15. Study design
▸ LUTS were quantified using the 7
question IPSS and the patients were
classified as having mild, moderate or
severe symptoms according the final IPSS
score: IPSS from 0 to 7 – mild symptoms;
IPSS from 8 to 19 – moderate symptoms;
IPSS > 20, severe symptom.
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16. Study design
▸ IH was detected by physical examination.
▸ Noninvasive parameters of evaluation included
post-void residual (PVR) and measurement of
prostate volume (PV) by ultrasound.
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17. RESULTS
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18. Age Distribution
0
2
4
6
8
10
12
14
16
18
20
45-49 50-54 55-59 60-64 >65
2
5
11
3 4
GROUP A GROUP B

19. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
GROUP A
GROUP B
MILD
MODERATE
SEVERE
Symptom severity distribution for group A
and B
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GROUP MILD MODERATE SEVERE
GROUP A 2(12.5%) 13(49%) 10(38.5%)
GROUP B 8(30%) 11(45%) 6(20%)

20. MEAN IPSS, POST VOID RESIDUAL
URINE, PROSTATE VOLUME
▸ There is a significant difference between mean
values of GROUP A & GROUP B
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GROUP IPSS POST VOID
RESIDUE(ml)
PROSTATE
VOLUME(ml)
GROUP A 19.6 55.6 48.9
GROUP B 13.2 37.8 50.7

21. RESULTS
▸ A statistically
significant
difference was
found between
the PVR mean
values between
groups A and B
(p<0.05).
▸ We did not
found any
correlation
between PV,
and PVR with
the LUTS
intensity
assessed
through the
IPSS.
▸ We did not found a
statistically significance
difference between the
number of men with mild,
moderate and severe
LUTS symptoms
between groups A and B,
but the presence of IH
correlated with a higher
IPSS.
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22. RESULTS
▸ A possible explanation for this
association remains on the
fact that patients with
obstructive voiding
dysfunction may need to strain
to void, this effort over time
may have a direct impact on
the abdominal wall
contributing to the
development of IH
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23. RESULTS
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▸ another possibility remains on
the fact that IH and BPH are
part of the aging process
which incorporates other
functional and anatomic
disorders,
▸ if all these changes have a
cause effect relation or are
independent factors just
related to the aging process,
are still to be defined.

24. CONCLUSION
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1 3
2
Patients with IH present
higher IPSS.
The role of IPSS as a marker to predict the
development of clinical IH need further study.
However prostate size does not have role in IH.

25. Thanks!
Any questions?
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