Incisional hernia: a possible complication after the orthotopic urinary diversion?

One of the complications of abdominal surgical procedures is incisional hernia. This complication is encountered in different rates due to the surgical technique, type of urinary diversion preferred, and whether the patient has additional risk factors or not.

In this study, 145 patients who had undergone urinary diversions in our clinic were evaluated between the years 1989 and 2002. Of those, 17 were treated by Mainz pouch type II urinary diversion, 47 by Indiana type urinary diversion and 81 patients were treated by orthotopic urinary diversions.

Incisional hernia did not occur in any of the patients who had undergone Mainz pouch type II and Indiana type urinary diversions. Eleven of 145 patients (7.5%) who had undergone urinary diversions developed incisional hernia. All of these incisional hernia occurred in patients who had undergone orthotopic type urinary diversion. These incisional hernias occurred within the first postoperative year (2-8 months).

We believe that increased intraabdominal pressure for micturition is the predisposing factor for the development of incisional hernias. Furthermore, the patients must avoid from sudden increase of intraabdominal pressure such as suddenly, strong valsalva maneuver during voiding. And we believe usefully press doing from the outside to abdomen during voiding (crede maneuver).