We demonstrated that parastomal hernia will develop in nearly a third of patients after radical cystectomy with ileal conduit diversion. Prior laparotomy and severe obesity are independent risk factors. Preoperative counseling and preventative measures regarding parastomal hernia formation should be emphasized, particularly in these at risk patients.

Purpose To examine the outcomes of patients with recurrent or de novo renal lesions treated with repeat partial nephrectomy on a solitary kidney. Methods We reviewed the records of patients who underwent nephron-sparing surgeries at the NCI from 1989 to 2008. Patients were included in the analysis if they underwent a repeat partial nephrectomy on a solitary kidney. Perioperative, functional, and oncologic outcomes were assessed. Functional outcomes were evaluated using the MDRD equation for eGFR. Oncologic efficacy was examined by the need for subsequent repeat renal surgery and development of metastatic disease. Results Twenty-five patients were included in the analysis. The median number of tumors resected was 4; with median EBL of 2,400ml, and median operative time of 8.5 hours. Perioperative complications occurred in 52% of the cases and included one mortality, and the loss of 3 renal units. There was a decline in eGFR (p<0.01) on the first follow up visit within 3 months after surgery, but at the 1 year follow up, the difference was not significant (p=0.12). Surgical interventions were recommended to eight patients (38%) for recurrent or de-novo tumors at a median time of 36 months, while metastasis-free survival of the cohort at an average of 57 months (range 3–196, median 50 months) was 95%. Conclusions Repeat partial nephrectomy for patients with a solitary kidney is a high risk alternative. Although the complication rates are high and there is a modest decline in renal function, most patients remain free from dialysis with acceptable oncologic outcomes at intermediate follow up.