MP24-17 NATURAL HISTORY, PREVALENCE, PREDICTORS & OUTCOMES OF PARASTOMAL HERNIA AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2017MP24-17 NATURAL HISTORY, PREVALENCE, PREDICTORS & OUTCOMES OF PARASTOMAL HERNIA AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY Youssef Ahmed, Ahmed Hussein, Paul May, Basim Ahmad, Taimoor Ali, and Khurshid Guru Youssef AhmedYoussef Ahmed More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , Paul MayPaul May More articles by this author , Basim AhmadBasim Ahmad More articles by this author , Taimoor AliTaimoor Ali More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Parastomal hernia (PH) is a frequent complication of urinary diversion after radical cystectomy. We investigated the prevalence, predictors and outcomes of PH. Clinical and radiologic evidence of PH was also investigated. METHODS Retrospective review of 446 patients who underwent RARC at our institution from 2005 was conducted. Data was reviewed for demographics, clinical findings, imaging results and other perioperative outcomes. Radiologic PH was defined as protrusion of abdominal content through the stoma defect in the abdominal wall. PH was further described in terms of symptoms and their management. Kaplan Meier method was used to depict time to developing PH and logistic regression to evaluate predictors of PH. RESULTS 384 patients who underwent RARC and IC were included in the analysis. Mean age was 70 years with median follow up of 18 months (IQR 6.8-34-.7). 74 (19%) patients had radiological evidence of PH, 24 (32%) were symptomatic and 8 (11%) underwent treatment. Median time to develop PH was 13 months (IQR 8.8-22). PH occurred at a rate of 10%, 33% and 36% at 1, 3 and 5 years respectively (Fig 1). Median time to symptoms was 24 months after RARC (IQR 7-39.6) and (8 months after radiological diagnosis. Patients with PH had significantly higher BMI (30 vs 28, p=0.009), longer overall operative time (347 vs 388 min, p=0.01), urinary diversion time (128 vs 108 p=0.03) and higher blood loss (400 vs 250, p=0.01). The incidence of PH was studied based on incorporation of intra-corporeal diversion in the program (Fig 2). On Multivariable analysis operative time was the only variable associated with higher incidence of PH (OR 1.25, 95% CI 1.02-1.04, p<0.001). CONCLUSIONS PH is a common complication following RARC (20%). Approximately one-third will develop symptoms and 10% will require surgical treatment. Risk for developing PH plateaus after the 3rd year. Longer operative time was associated with higher incidence of PH. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e308 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Youssef Ahmed More articles by this author Ahmed Hussein More articles by this author Paul May More articles by this author Basim Ahmad More articles by this author Taimoor Ali More articles by this author Khurshid Guru More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...