You have accessJournal of UrologyBladder Cancer: Invasive (III)1 Apr 20131759 RISK FACTORS FOR THE DEVELOPMENT OF PARASTOMAL HERNIA AFTER RADICAL CYSTECTOMY Timothy F. Donahue, Hebert A. Vargas, John P. Sfakianos, Matthew Kent, William M. Hilton, Melanie Bernstein, Guido Dalbagni, and Bernard H. Bochner Timothy F. DonahueTimothy F. Donahue New York, NY More articles by this author , Hebert A. VargasHebert A. Vargas New York, NY More articles by this author , John P. SfakianosJohn P. Sfakianos New York, NY More articles by this author , Matthew KentMatthew Kent New York, NY More articles by this author , William M. HiltonWilliam M. Hilton New York, NY More articles by this author , Melanie BernsteinMelanie Bernstein New York, NY More articles by this author , Guido DalbagniGuido Dalbagni New York, NY More articles by this author , and Bernard H. BochnerBernard H. Bochner New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2888AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Parastomal hernia (PH) is a recognized complication of radical cystectomy (RC) and conduit diversion. The incidence varies depending on the length of follow up and if the diagnosis is made clinically or radiographically. Currently, it is unknown what factors influence the development of PH. We conducted a retrospective review to determine risk factors associated with developing a parastomal hernia following RC. METHODS In an IRB approved study, the records of 328 consecutive bladder cancer patients with clinical and radiographic follow up who underwent RC and ileal conduit between 2006 and 2010 were reviewed. We defined PH as radiographic evidence of the protrusion of abdominal contents through the abdominal wall defect created by forming the stoma. Postoperative staging CT scans (n=1465) were read by a radiologist blinded to patient characteristics and the grade of the PH was recorded (Grade 1: prolapse of conduit; Grade 2: abdominal fat or omental herniation; Grade 3=bowel herniation). Univariate and multivariate Cox regression analyses were used to determine factors associated with PH development. RESULTS Evidence of a radiographic PH was identified in 110 (33.5%) patients. Grade 1, 2, and 3 parastomal hernias developed in 7 (6%), 70 (64%), and 33 (30%) patients, respectively. The overall risk of developing a PH was 26% (95% CI 21%, 32%) and 47% (95% CI 40%, 55%) at 1 and 2 years, respectively (Fig 1). Median follow-up for patients who did not develop PH was 12 months and median hernia free survival time was 2.4 years (95% CI 1.7, 3.3). Clinical diagnosis of PH was documented in 71 of 110 patients (65%) and 24 (34%) were symptomatic. 14 (20%) patients with clinical PH were referred for possible PH repair and 6 (9%) had surgery. Two PH repairs were done emergently for bowel incarceration. By univariate and multivariate analysis, patients who were male (HR 2.42, 95% CI 1.59, 3.69; p <0.0005), had a higher BMI (HR 1.08, 95% CI 1.04, 1.13; p <0.0005), and had a lower preoperative albumin (HR 0.43, 95% CI 0.23, 0.80; p = 0.008) were more likely to develop PH after adjusting for age, diabetes, smoker, COPD, estimated blood loss, Turnbull vs. end-stoma ileal conduit, prior abdominal surgery, preoperative radiation therapy, and neoadjuvant chemotherapy. CONCLUSIONS The overall risk of radiographic evidence of PH was 26% (95% CI 21%, 32%) and 47% (95% CI 40%, 55%) at 1 and 2 years, respectively. Increased BMI, male gender, and lower preoperative albumin levels were associated with an increased risk of developing PH after ileal conduit. There was a low likelihood of requiring emergent surgery for PH in our cohort. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e723 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy F. Donahue New York, NY More articles by this author Hebert A. Vargas New York, NY More articles by this author John P. Sfakianos New York, NY More articles by this author Matthew Kent New York, NY More articles by this author William M. Hilton New York, NY More articles by this author Melanie Bernstein New York, NY More articles by this author Guido Dalbagni New York, NY More articles by this author Bernard H. Bochner New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...