Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion

Hussein, Ahmed A.; Ahmed, Youssef; May, Paul; Ali, Taimoor; Ahmad, Basim; Raheem, Sana; Stone, Kevin; Hasasnah, Adam; Rana, Omer; Cole, Adam; Wang, Derek; Loud, Peter A.

doi:10.1016/j.juro.2017.08.112

Cited by 32 publications

(48 citation statements)

References 29 publications

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“…After removing duplicates, screening titles and abstracts, and evaluating full texts, 15 (9,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) of 469 studies containing 4,252 patients were included to evaluate the incidence of PH after RC and IC. The studied population came from USA (9,12,14,15,18,20,24,25), China (22), Switzerland (23), Denmark (13), Japan (16,17), Spain (19), and Sweden (21). The vast majority of articles were reported retrospectively, and the span of median time to diagnosis of PH was from 11 to 28.8 months.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…They observed that 80% (1/5) of initial type 1 hernias progressed to type 3 while 33% (30/90) of initial type 2 hernias progressed to type 3. In addition, Hussein et al (12) reported that 32% patients developed PH after robot-assisted RC (RARC) and IC at 3 years. PH-related symptoms, such as pain, bowel incarceration, appliance difficulties, discomfort, or PH-induced leakage, were reported in six studies (9,12,14,16,19,20), and the incidence rate ranged from 15% to 44%.…”

Section: Incidencementioning

confidence: 99%

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Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis

Feng¹,

Wang²,

Yang³

et al. 2021

Transl Cancer Res TCR

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Background: Our aim is to report the incidence and risk factors of parastomal hernia (PH) after radical cystectomy (RC) and ileal conduit (IC) diversion with a cumulative analysis.Methods: Various databases, including PubMed, the Cochrane Library, Embase and Web of Science, were retrieved electronically and manually to identify eligible studies from inception to August 20, 2020. Two reviewers independently searched the above databases and selected the studies using prespecified standardized criteria. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in the included studies, and the data was completed by STATA version 14.2.Results: Fifteen studies were included in the final analysis. A pooled analysis of eight studies representing 1,878 patients reported the incidence of overall radiographic PH was 23% (95% CI: 17-29%). The 1-year PH incidence rate and 2-year incidence rate of RC and IC were 14% (95% CI: 6-22%) and 26% (95% CI: 14-38%), respectively. A pooled analysis of nine studies reported the incidence of clinically evident PH was 15% (95% CI: 10-19%). PH-related symptoms were reported in six studies, and the pooled result was 29% (95% CI: 24-33%), and a pooled analysis of ten studies showed that 20% (95% CI: 11-28%) of patients required surgical repair. However, it's noteworthy that among symptomatic PH patients undergoing surgical repair, the pooled analysis of five studies showed that up to 26% (95% CI: 16-36%) of patients suffered PH recurrence. The most frequent risk factor was body mass index (BMI). Patients with BMI ≥22.9 kg/m 2 experienced 2.92-fold higher risk of PH than their counterparts [hazard ratio (HR): 2.92; 95% CI: 1.65-5.19].Conclusions: Our findings indicated that the PH incidence rate after RC and IC was significantly higher in radiographic evaluation than that of clinical examination, and the recurrence of repairment is considerable for patients requiring reconstruction.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Incidencementioning

confidence: 99%

Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis

Feng¹,

Wang²,

Yang³

et al. 2021

Transl Cancer Res TCR

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“…It is noteworthy that no cases of parastomal hernia were observed. Hussein et al [35] reported that the incidence of parastomal hernia after RC and IC was as high as 20%, of which 15% patients required surgery. The absence of parastomal hernia in this study was mainly due to our modi cations.…”

Section: Discussionmentioning

confidence: 99%

Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

Zhang

Bai

et al. 2021

Preprint

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Background: To evaluate the surgical effects and oncological outcomes of modified ileal conduit (IC) after radical cystectomy (RC) for bladder cancer.Methods: A single-centre cohort of 211 consecutive bladder cancer patients who underwent RC + modified IC from September 2012 to August 2019 were retrospectively studied. Demographic data, perioperative results, complications 30 and 90 days after surgery and oncological outcomes were recorded. Kaplan–Meier method was used to plot the stage-specific survival results. The 5-year recurrence-free survival (RFS）and overall survival (OS) rate was calculated. Univariate and multivariate Cox regression analyses assessed the predictive risk factors on survival rate.Results: Overall, 211 patients received modified IC after RC. The median operative time (OT) was 315 minutes (IQR, 260–375 minutes), and the median estimated blood loss (EBL) was 500 ml (IQR, 300–900 ml). There were a total of 103 (48.8%) complications. There were 35, 54, 11, and 2 cases of grade I, II, III, and IV complications, respectively; of which 89 cases were grade I and II, accounting for 87.3% of total cases. There were 38 cases of preoperative hydronephrosis and 22 cases of postoperative hydronephrosis. There were 19, 24, 108, 40, and 20 cases of PT0, T1, T2, T3, and T4, respectively, in postoperative pathological stages. The median lymphadenectomy was 14 (IQR, 6–18), and lymph node was found positive in 18 patients. The median follow-up time was 26 months (IQR, 13–43), with a total survival of 177 (83.9%), an RFS of 171 (81%), and 34 deaths. The estimated 5-year OS and RFS rates were 76.80% and 79.10%. Preoperative comorbidities, pathological stage, grade, and lymph node involvement were important influencing factors for OS, while preoperative comorbidities and high pathological grade were important influencing factors for RFS.Conclusions: Modified IC after RC not only can achieve lower postoperative complications, especially the lower incidence of uretero-ileal anastomosis and stoma-related complications but can also achieve the established oncological outcomes of critical radical surgery.

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“…There is a paucity of prospective data about the natural history and trajectory of PSH and whether PSH severity progression can be arrested [ 8 , 9 ]. PSH can be repaired surgically but results to date have been disappointing, with reported recurrence rates of 30 to 76% [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia

Hubbard

Beeken

Taylor

et al. 2020

Pilot Feasibility Stud

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Background Parastomal hernia (PSH) can be repaired surgically, but results to date have been disappointing, with reported recurrence rates of 30 to 76%. Other types of intervention are therefore needed to improve the quality of life of people with PSH. One potential intervention is physical activity. We hypothesise that the intervention will increase core activation and control across the abdominal wall at a site of potential weakness and thus reduce the risk of PSH progression. Increases in physical activity will improve body image and quality of life (QoL). Methods Subjects and sample There were approximately 20 adults with a bowel stoma and PSH. People with previous PSH repair will be excluded as well as people who already do core training. Study design This is a feasibility study of a randomised controlled trial with 2 months follow-up, in 2 sites using mixed methods. Stage 1 involves intervention development and in stage 2, intervention and trial parameters will be assessed. Intervention A theoretically informed physical activity intervention was done, targeting people with PSH. Main outcome of feasibility study The main outcome is the decision by an independent Study Steering Committee whether to proceed to a full randomised controlled trial of the intervention. Other outcomes We will evaluate 4 intervention parameters—fidelity, adherence, acceptability and safety and 3 trial parameters (eligible patients’ consent rate, acceptability of study design and data availability rates for following endpoints): Diagnosis and classification of PSH Muscle activation Body composition (BMI, waist circumference) Patient reported outcomes: QoL, body image and physical functioning Physical activity; Psychological determinants of physical activity Other data Included are other data such as interviews with all participants about the intervention and trial procedures. Data analysis and statistical power As this is a feasibility study, the quantitative data will be analysed using descriptive statistics. Audio-recorded qualitative data from interviews will be transcribed verbatim and analysed thematically. Discussion The feasibility and acceptability of key intervention and trial parameters will be used to decide whether to proceed to a full trial of the intervention, which aims to improve body image, quality of life and PSH progression. Trial registration ISRCTN15207595

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Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion

Cited by 32 publications

References 29 publications

Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis

Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis

Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia

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