Risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit

Abstract

Objective To investigate the incidence, risk factors and natural history of parastomal hernia (PSH). Materials and Methods We reviewed the records of patients who underwent radical cystectomy (RC) and ileal conduit (IC) procedure between 2007 and 2020. Patients who had available follow‐up computed tomography (CT) imaging were included in this study. All CT scans were re‐reviewed for detection of PSH according to Moreno‐Matias classification. Patients who developed hernia were followed up and classified into stable or progressive (defined as radiological upgrading and/or need for surgical intervention) groups. Multivariable Cox regression was performed to identify independent predictors of hernia development and progression. Results A total of 361 patients were included in this study. The incidence of radiological PSH was 30%, graded as I (56.5%), II (12%) and III (31.5%). The median (interquartile range [IQR]) time to radiological hernia was 8 (5–15) months. During the median (IQR) follow‐up of 27 (13–47) months in 108 patients with a hernia, 26% patients progressed. The median (IQR) time to progression was 12 (6–21) months. On multivariable analysis, female gender (hazard ratio [HR] 1.86), diabetes (HR 1.81), chronic obstructive pulmonary disease (COPD; HR 1.78) and higher body mass index (BMI; HR 1.07 for each unit) were independent predictors for radiological PSH development. No significant factor was found to be associated with hernia progression. Conclusion Radiological PSH after RC and IC occurred in 30% of patients, a quarter of whom progressed in a median time of 12 months. Female gender, diabetes, COPD and high BMI were independent predictors for radiological hernia development.

Reply by Authors

“…Despite the heterogeneity of data in the literature concerning diagnostic methods and duration of follow-up, most studies, including those conducted by our group, have reported an incidence rate of 25% to 40% for PSH. 1,2 Prophylactic mesh placement has been proposed to decrease this risk; however, our trial did not demonstrate a significant benefit of this strategy within a 2year follow-up period following surgery. 3 Several risk factors have been shown to increase the risk of PSH.…”

“…This has been confirmed in our prior (retrospective) study with an HR of 1.07 for each unit increase in the BMI. 2 We recognize that the majority of patients enrolled in our trial fell into the categories of normal weight or overweight. This might be influenced by the nature of a single-center study, yet through a randomized clinical trial including all eligible comers for such a procedure.…”

The Challenges of Urological Research in COVID-19 Era: Lessons Learned for Immediate Response to the Pandemic

“…Some of these studies were already published or presented at the regional and/or international meetings. [17][18][19][20] 2. Restrictions on the presence of staff, including research team, in the labs and/or office and/or operating room: During the first phase of research ramp-up, only 5%-10% of the normal on-site research activity was allowed (Fig.…”

Re: re: risk factors and natural history of parastomal hernia following radical cystectomy and ileal conduit

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We are thankful for the comments regarding our manuscript [1] and welcome the opportunity to discuss the highlighted points.

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