Pd21-05 the Relationship Between Ileal Conduit Fascial Incision Technique and Future Psh: A Retrospective Assessment

You have accessJournal of UrologyReconstruction: Augmentation, Substitution, Diversion (PD21)1 May 2024PD21-05 THE RELATIONSHIP BETWEEN ILEAL CONDUIT FASCIAL INCISION TECHNIQUE AND FUTURE PSH: A RETROSPECTIVE ASSESSMENT Diboro L. Kanabolo, Sarah K. Holt, Jonathan L. Wright, and George R. Schade Diboro L. KanaboloDiboro L. Kanabolo , Sarah K. HoltSarah K. Holt , Jonathan L. WrightJonathan L. Wright , and George R. SchadeGeorge R. Schade View All Author Informationhttps://doi.org/10.1097/01.JU.0001008888.07102.14.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ileal conduit urinary diversion is associated with an ∼50% risk of parastomal hernia PSH) within 2 years of surgery. Despite this, no well-established "best" practice for stoma creation exists. Recently, we demonstrated that fascial incision type (linear vs. cruciate) and reinforcement has a predictable influence on herniation potential in in vitro models. Consequently, our objective was to assess assess the relationship between stomal fascial incision type and subequent development of PSH within our institution. METHODS: We retrospectively reviewed all patients undergoing radical cystectomy and ileal conduit (RCIC) at our institution from June 2018 to December 2022. Patients were considered eligible for inclusion if they underwent RCIC for bladder cancer and had at least 6 months of cross-sectional imaging follow up available. Institutionally, surgeons have differing practice patterns in IC maturation including linear incision, cruciate incision, and cruciate incision plus mesh in the abdominal fascia during ileal conduit construction. Primary outcome was PSH at most recent follow up. PSH was defined as radiographic evidence of bowel anterior to the abdominal fascia adjacent to the ileal conduit. Kaplen-Meier curves and Cox proportionate hazards modelling adjusting for age, sex and BMI were used to explore risk of PSH in the three techniques. RESULTS: 217 RCIC patients were eligible for review. Median age was 69 years (IQR: 64-75) and follow up was 1.56 years (IQR: 0.92-2.94) for the entire cohort. The overall PSH rate was 18.9% in the cruciate (n=29), 6.9% in the linear (n=3), and 21% (n=4) in the mesh groups. On multivariable analysis, both cruciate incision and cruciate with mesh techniques had a higher risk of PSH risk as compared to linear incisions, with adjusted risk estimates of HR 2.42 (95% CI: 0.73-7.99, p=0.14) and HR 4.63 (1.03-20.86, p=0.04) respectively. CONCLUSIONS: This small retrospective study suggests an association between fascial incision type, and subsequent PSH development. Further studies are needed to confirm these findings. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e455 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Diboro L. Kanabolo More articles by this author Sarah K. Holt More articles by this author Jonathan L. Wright More articles by this author George R. Schade More articles by this author Expand All Advertisement PDF downloadLoading ...