Reply by Authors

Abstract

We would like to thank Dahmen and colleagues for their valuable comments on our manuscript. 1 Despite the negative findings of our trial, the authors judiciously emphasized the potential benefit of prophylactic mesh in patients who are at high risk for developing parastomal hernia (PSH) following cystectomy and ileal conduit. Our prior study showed that female gender, diabetes, chronic obstructive pulmonary disease, and higher BMI are independent predictors for radiological PSH development. 2 Also, the current trial demonstrated a higher risk of PSH in patients with prior abdominopelvic radiation and those with a higher pathological stage. 1 In addition, patients with longer expected survival rates may benefit from prophylactic mesh placement, but verifying this would necessitate long-term follow-up.The other point that has been highlighted by the authors is technical modifications at the time of ileal conduit construction. To decrease the risk of PSH, prior studies have proposed some modifications, including stoma placement through vs lateral to the rectus muscle, Turnbull vs end stoma formation, and ileal conduit fixation to the rectus fascia. [3][4][5] Nevertheless, all these suggestions were based on retrospective studies and/or expert opinions, and there is no highlevel evidence supporting these strategies. Applying the best available surgical technique, along with addressing patient-related risk factors, can potentially reduce the risk of PSH. Although our proposed technique did not show a significant benefit in a 2-year follow-up, it is reproducible, quick, and safe, with potential applicability in patients at high risk of developing PSH following cystectomy and ileal conduit.