Incisional and Parastomal Hernia following Radical Cystectomy and Urinary Diversion: The University of Southern California Experience.
J Urol
; 196(3): 777-81, 2016 Sep.
Article
em En
| MEDLINE
| ID: mdl-27044570
ABSTRACT
PURPOSE:
Hernia is a common complication following radical cystectomy and urinary diversion. We investigated the clinical and radiological evidence for parastomal and incisional hernias, and their risk factors in a large cohort. MATERIALS ANDMETHODS:
Using an institutional review board approved prospective database we reviewed the records of 1,101 patients who underwent radical cystectomy from 2003 to 2013. Followup (median 57 months) was available for 670 patients. Of the 670 patients 92 underwent ileal conduit diversion using Turnbull stomas with a median followup 34 months. Patients were followed with computerized tomography cancer surveillance. Standardized criteria were used to define parastomal and incisional hernias by an expert radiologist. Multivariate logistic regression was done to identify independent predictors.RESULTS:
Parastomal hernia was diagnosed in 21 of 92 patients (23%) with a mean age at diagnosis of 76.5 years. Incisional hernia was present in 125 of 670 patients (18.7%) with a mean age at diagnosis of 68.6 years. Five patients had both hernia types. Of patients with parastomal and incisional hernias 11 (53%) and 111 (88.8%), respectively, were male. Mean body mass index was 27.5 and 27.3 kg/m(2) in patients with parastomal and incisional hernias, respectively. Mean parastomal and incisional defect sizes were 3.8 and 2.4 cm, respectively. In 18 patients (85%) parastomal hernias were clinically and radiologically evident, 5 patients were symptomatic and 2 underwent repair. In 51 patients (40%) incisional hernias were clinically and radiologically evident, 34 were symptomatic and 48 underwent repair. Multivariate logistic regression showed significant associations of incisional hernia with age, gender, incision length, orthotopic diversion and body mass index. Parastomal hernia had no significant association.CONCLUSIONS:
Hernia is common after cystectomy and diversion. Age, gender, body mass index, incision length and diversion type are risk factors for incisional hernia. Multi-institutional prospective studies may better identify patients at high risk.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Universidades
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Neoplasias da Bexiga Urinária
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Cistectomia
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Hérnia Incisional
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Nefrotomia
Tipo de estudo:
Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Urol
Ano de publicação:
2016
Tipo de documento:
Article