Anterior Perineal Hernia following Robot-Assisted Radical Cystectomy in a Male Patient: A Case of Transperineal Mesh Repair.

INTRODUCTION

Perineal hernia following radical cystectomy is exceedingly rare, and to our knowledge, no individual case report of anterior perineal hernia after robot-assisted radical cystectomy (RARC) with urethrectomy in a male patient has been described in the English-language literature. We report such a case, which was successfully repaired via a transperineal approach using mesh reinforcement.

CASE PRESENTATION: An 80-year-old man was incidentally diagnosed with an anterior perineal hernia containing small bowel on routine postoperative follow-up CT, 4 years after RARC, urethrectomy, and ileal conduit diversion for muscle-invasive bladder cancer with prostatic invasion. The patient was initially asymptomatic and managed conservatively; however, he subsequently developed symptoms consistent with subacute small bowel obstruction, for which surgical repair was indicated. Surgery was performed via a transperineal approach. After resection of the hernia sac and reduction of the small bowel, the hernia defect (2.5 × 2.5 cm) was repaired using a 4-armed (cruciate) mesh anchored anteriorly and laterally to the posterior surface of the pubic bone and the bilateral inferior pubic rami, and posteriorly to a cord-like fibrous structure representing perineal remnants, enabling tension-free reconstruction without injury to the rectum. No recurrence was observed at 6 months postoperatively.

CONCLUSIONS

This case highlights that perineal hernia can occur as a rare but clinically significant complication following radical cystectomy, even in male patients. A transperineal approach with mesh reinforcement, using the pubic bone and perineal remnants as fixation points, may represent a viable reconstructive option. Surgeons should be aware of this complication and select an individualized approach based on anatomical findings and surgical history.