EVOLVING EXPERIENCE WITH CONTINENT URINARY DIVERSION USING THE INDIANA POUCH

The Indiana continent urinary reservoir procedure for urinary diversion was performed in 46 patients. After the first 8 cases several modifications were made to the Indiana pouch. These modifications include complete detubularization of the colonic segment, construction of the pouch augmented with a U-shaped patch of ileum and, more recently, the use of stapled plication. The mean postoperative follow-up period was 46 mo (range 4.5-74.1 mo). There was 1 perioperative death and this case was excluded from the follow-up study. Late complications related to the urinary reservoir occurred in 12 (26.7%) of the 45 patients. Stone formation was observed in 5 patients. Out of 45 patients, 42 achieved complete urinary continence while 2 suffered mild nocturnal incontinence and 1 had significant leakage. Three had unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy demonstrated no reflux into the upper urinary tract in all of the follow-up cases. Loopography of the efferent limb showed that a staple-plicated ileum functions better than a suture-plicated one in terms of reliability of the continence mechanism and ease of catheterization. The Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because it is technically easy to perform and it has a low revision and high continence rate.