While most PSHs are asymptomatic, problems can arise, ranging from mild discomfort to life-threatening complications, such as perforation, obstruction, and/or strangulation. There have been different methods to repair such a complication; however, there is a paucity of data in the urology literature regarding the outcomes of such PSH and recurrence rate. Therefore, this study aimed to report perioperative and long-term postoperative outcomes of patients with IC urinary diversion undergoing PSH repair.
We reviewed records of patients who underwent PSH repair following cystectomy and IC urinary diversion between 2003 and 2022, and of these patients, we identified 36 who met the inclusion criteria of having at least one parastomal hernia repair following cystectomy and IC diversion at our institution. The primary outcome was hernia recurrence. Secondary outcomes included perioperative complications.
We found that the vast majority of PSH repair cases were done electively, with 4 completed urgently in the setting of a small bowel obstruction. Overall, 47% of patients had a recurrence, with the median time to recurrence of 9 months. A variety of repair techniques were captured including direct repair with mesh,2 direct repair without mesh,4 stoma relocation with mesh,5 and stoma relocation without mesh.7 No statistically significant differences in recurrence rates were observed amongst different repair techniques. Similar results were observed when comparing open approaches to minimally invasive ones.
Overall, this report contains one of the largest series of PSH repairs in the Urology literature. Perioperative 90-day complication rate was 28% (55% Clavien-Dindo ≤ 2). Over 50% of patients had no recurrence in the median 2-year follow-up time, but longer follow-up is required to understand the durability of these results. Given the individual success of PSH repairs is mixed, more attention may be needed on risk factors for PSH development.3 Additionally, further work is required on how effective prophylactic approaches to reduce PSH rates are, such as the PUBMIC trial.4
Written by: Taseen F. Haque & Hooman Djaladat, Urology Department, University of Southern California, Los Angeles, CA
References:
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- Lin-Brande M, Nazemi A, Pearce SM, et al (2019) Assessing trends in urinary diversion after radical cystectomy for bladder cancer in the United States. Urol Oncol Mar 37(3):180e. 1-180.e9
- Ghoreifi A, Allgood E, Whang G, Douglawi A, Yu W, Cai J, Miranda G, Aron M, Schuckman A, Desai M, Gill I, Daneshmand S, Duddalwar V, Djaladat H. Risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit. BJU Int. 2022 Sep;130(3):381-388. doi: 10.1111/bju.15658. Epub 2021 Dec 6. PMID: 34837315.
- Djaladat H, Ghoreifi A, Tejura T, Miranda G, Cai J, Sheybaee Moghaddam F, Aldana I, Sotelo R, Gill I, Bhanvadia S, Schuckman A, Desai M, Aron M, Daneshmand S, Duddalwar V. Prophylactic Use of Biologic Mesh in Ileal Conduit (PUBMIC): A Randomized Clinical Trial. J Urol. 2024 Jun;211(6):743-753. doi: 10.1097/JU.0000000000003902. Epub 2024 Apr 15. PMID: 38620056.