PHILADELPHIA (April 29, 2025) — Parastomal hernia is a common complication among patients who undergo bladder removal and ileal conduit urinary diversion. Now, a new study presented by Fox Chase Cancer Center clinicians at the American Urological Association’s (AUA) Annual Meeting supports the use of partially absorbable synthetic, non-biologic parastomal mesh to significantly reduce this risk in real-world practice.
The study found a very low rate of parastomal hernia when the mesh was used to reinforce the abdominal wall in select patients, with a similarly low rate of mesh-related complications.
“We found that placing the mesh did not result in a significant increase in infections or stenosis,” said first author Tamir Sholklapper, MD, MS, a resident in the Department of Urology at Fox Chase. “Most importantly, patients did not develop debilitating hernias around their stoma sites.”
Bladder removal, also known as cystectomy, is typically performed in patients with bladder cancer or those whose bladders no longer function properly. The most common procedure involves rerouting urine through a segment of intestine so that it exits the body through a stoma in the abdominal wall, an area prone to herniation.
Around 25% of patients who undergo cystectomy with an ileal conduit develop some form of parastomal hernia, which can range from mild and unsightly to severe cases that cause pain, obstruct intestinal content or urine flow, and require further surgery.
A previous prospective European trial showed that using partially absorbable synthetic mesh could decrease the frequency of parastomal hernias, but real-world experience has been limited. In addition, other trials involving biologic mesh have shown minimal benefit, which has confused the narrative for surgeons considering prophylactic mesh placement.
Led by Alexander Kutikov, MD, FACS, Chair of the Department of Urology and a member of the executive management team of the Fox Chase - Temple Urologic Institute, the Fox Chase team has used this partially absorbable mesh routinely for several years. Their adoption followed publication of the prospective European trial and was done under the guidance of Sameer Patel, MD, FACS, Chief of the Division of Plastic and Reconstructive Surgery at Fox Chase.
In the current study, Fox Chase clinicians analyzed data from 43 patients in whom the mesh was used. Of these, only three (7%) developed a parastomal hernia. Notably, in two cases the hernias were detected on imaging only and were not symptomatic.
“At the end of the day, having only one patient with a clinical parastomal hernia is almost unheard of, especially when we typically expect a 25% rate,” Sholklapper said. Complications were also minimal. Only one patient developed stomal stenosis and no infections occurred, an important finding given the historical concern for infection risk with synthetic mesh.
“This study underscores that, in a real-world setting, the same partially absorbable mesh used in the European trial can be a game-changer for clinical practice in the United States,” Sholklapper said.
The study, “Very Low Rate of Parastomal Hernia Using Partially Absorbable Macroporous Mesh for Prophylactic Reinforcement in Ileal Conduit Urinary Diversion: A Collaborative Approach Between Urology and Plastic/Reconstructive Surgery,” was presented at the AUA meeting, which is being held in Las Vegas April 26-29.