Synthetic mesh repair of an anterior perineal hernia following robotic radical urethrocystectomy

 Vol. 43 (x): 2017 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0534


CHALLENGING CLINICAL CASES

Horacio J. Alvarez Garzón 1,2, Thomas Maubon 3, Camille Jauffret 3, Pierre Vieille 2, Brigitte Fatton 2, Renaud de Tayrac 2
1 Department of Urology, Hospital Privado Centro Medico de Córdoba, Argentina; 2 Department of Obstetrics and Gynaecology, Nîmes University Hospital, Nîmes, France; 3 Department of Urology and Surgical Oncology, Institut Paoli Calmettes, Marseille, France

ABSTRACT

Introduction: Perineal hernia is a protrusion of intra-abdominal viscera through a defect in the pelvic floor and is a rare but challenging complication after extensive abdominoperineal surgery. There have been small series published after colorectal exenteration, but no cases have been reported after radical cystectomy and urethrectomy.

Case Presentation: A 68 years old woman developed an anterior perineal hernia, with no vaginal prolapse, after an anterior exenteration for bladder cancer. A perineal approach with the use of a synthetic polypropylene mesh was chosen to resolve the condition. After 6 months of follow-up, the patient has no symptoms or recurrence of the anterior perineal hernia.

Conclusion: To our knowledge, this case is the first report of perineal hernia after radical urethrocystectomy. Although being a case report, this article describes a potential and challenging complication after extensive anterior pelvic surgery, that could increase its incidence in the future. Literature review shows that whether perineal, abdominal or combined approach is chosen, surgery must respect hernia repair principles.

Keywords: Perineum; Pelvis; Cystectomy

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