EDITORIAL COMMENT

Abstract

Placement of prophylactic mesh at the time of ileal conduit urinary diversion is a controversial topic. On one hand, prophylactic parastomal hernia mesh has been found to decrease the rate of clinically detected parastomal hernia with no mesh complications in randomized studies 1 Liedberg F. Kollberg P. Allerbo M. et al. Preventing parastomal hernia after ileal conduit by the use of a prophylactic mesh: a randomised study. Eur Urol. 2020; 78: 757-763 Google Scholar and, as the current authors find, the approach has been found to be cost effective. 2 Saha S. Gerdtham U. Bläckberg M. Kollberg P. Liedberg F. Cost effectiveness of the use of prophylactic mesh to prevent parastomal hernia after urinary diversion with an ileal conduit. Eur Urol Open Sci. 2022; 40: 9-15 Google Scholar , 3 Kanabolo D.P.S. Park S. Prophylactic mesh placement with ileal conduit: a cost effectiveness analysis. Urology. 2023; (S0090-4295(23)00368-0)https://doi.org/10.1016/j.urology.2023.03.041 Google Scholar On the other hand, placement of prophylactic parastomal hernia mesh is not widely adopted in clinical practice. One reason for lack of adoption may be because the absolute rate of symptomatic parastomal hernia repairs that require surgical intervention is low because interventions are limited to cases with complications from the parastomal hernia such as bowel or conduit obstruction or skin breakdown from pouching challenges. Consequently, it is unclear how prophylactic mesh placement impacts the span of patient experience with parastomal hernia, which may range from asymptomatic to life threatening. Currently, no urologic studies incorporate patient-reported outcome measures regarding stoma satisfaction or impact on daily functioning, though efforts are underway to address this question in colorectal collaborative groups. 4 Blackwell S. Pinkney T. Quality of life and parastomal hernia repair: the PROPHER study. Hernia. 2020; 24: 429-430 Google Scholar As such, a key question remains unanswered in the urologic literature: Does prophylactic parastomal hernia mesh placement improve long-term patient quality of life and decrease the need for parastomal hernia repair?