"Uro-abdominoplasty": an adaptation of abdominal contouring for revision of complicated urostomies.

Background: The aim of this study was to describe the indications, surgical technique and outcomes of abdominoplasty as a novel tool for revising complicated urostomies.

Patients And Methods: Four patients (3 female, 1 male; mean body mass index = 32 kg/m; mean age = 56 years) who underwent abdominoplasty for urostomy revision 2007-2009 were identified. Ileal conduits had been performed following ablative or diversion surgery for cervical carcinoma, bladder carcinoma, interstitial cystitis, and neuropathic bladder. A postal questionnaire was used to establish pre- and postabdominoplasty stoma function.

Results: Patients were referred to the reconstructive team with problems fitting their urostomy-appliance leading to urinary leakage, skin irritation, and social embarrassment. Uro-abdominoplasty indications included multiple abdominal scars (n = 2), large abdominal apron (n = 4), and deep skin creases (n = 2). Three patients had undergone previous failed urostomy repositioning or peristomal liposuction. The joint plastic surgical-urological operations lasted a mean of 3 hours, with no major postoperative complications. Patients were discharged 8 days later. Of 4 patients, 3 reported improved appliance fitting and reduced urinary leakage (>50%) and the remaining patient had intermittent leakage due to a persistent abdominal fold superiorly, and has since undergone reverse abdominoplasty. Two patients complained of long-term lower abdominal numbness, but all 4 were satisfied with the aesthetic improvement.

Conclusions: Abdominoplasty has been successfully used in our center for the purpose of improving urostomy dysfunction of intractable mechanical leakage by creating a flatter surface for appliance fitting. Uro-abdominoplasty widens the reconstructive repertoire of plastic surgeons and can be considered in those who have exhausted conservative or simpler surgical solutions.