Abstract
You have accessJournal of UrologyCME1 Apr 2023MP65-03 ASSESSMENT OF UROSTOMY PARASTOMAL HERNIATION FORCES AND PREVENTION STRATEGIES Diboro Kanabolo, Adam Maxwell, Yashwanth Nanda Kumar, Ekaterina Kuznetsova, and George Schade Diboro KanaboloDiboro Kanabolo More articles by this author , Adam MaxwellAdam Maxwell More articles by this author , Yashwanth Nanda KumarYashwanth Nanda Kumar More articles by this author , Ekaterina KuznetsovaEkaterina Kuznetsova More articles by this author , and George SchadeGeorge Schade More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately 10,000 patients undergo cystectomy with ileal conduit diversion annually in the USA, of which∼50% will subsequently develop a parastomal hernia (PSH) at 2 years. Despite this, no well-established “best” practice for stoma creation exists. Due to the knowledge gap between urostomy surgical factors and abdominal wall forces, we developed a silicone and ex-vivo porcine fascia-based model for study. Our objective was to measure the relationship between incision size/type/material and axial tension force (ATF) as a surrogate for herniation force. This model was then used to evaluate a clinically applicable prevention strategy. METHODS: See system in Fig. 1a. Using incisions (linear, cruciate, circular) ranging from 1 to 3 cm (0.5cm increments) in 0.5mm silicone sheets, a dynamometer was hooked to a Foley catheter at the drainage aperture. Balloons were hydrated to 125% incision dimension. Upward ATF was recorded until balloon herniation and repeated up to N=5 membranes/size. Clinically applicable sized fascia was then used. To test force with suture, 4-0 Nylon purse string suture 1.5mm from incision edge were used (1b). A plastic tab 10% of incision diameter was laid while tying suture to prevent incisional constriction. RESULTS: The silicone ATF for herniation varied widely by incision type (Range 2.36 – 35.05 N). Linear ATF was highest, matched for size. Cruciate ATF was significantly higher than circular for each size. 3 cm incisions in ex vivo porcine fascia (Fig. 2) performed similarly. Suture reinforcement significantly raised herniation ATF for all incision types in both silicone and fascia. For example, for 3 cm cruciate, suture increased ATF 2.4-fold in silicone (p=0.008) and 3.3-fold in fascia (p=0.0001, Fig. 2). CONCLUSIONS: This ex-vivo study suggests incision type, size, and suture reinforcement have predictable influences on ATF for herniation. En-bloc porcine and cadaveric human studies are underway to assessing these factors in more clinically optimized models. If confirmed, these data may be used to standardize urostomy creation, reducing PSH risk. Source of Funding: American Urology Association, Urology Care Foundation Research Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e890 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diboro Kanabolo More articles by this author Adam Maxwell More articles by this author Yashwanth Nanda Kumar More articles by this author Ekaterina Kuznetsova More articles by this author George Schade More articles by this author Expand All Advertisement PDF downloadLoading ...
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