Modified Indiana pouch

The modified continent Indiana pouch is based upon the terminal 8 to 12 cm. of ileum and 26 to 30 cm. of right colon. Our modifications include complete detubularization of the colonic segment with an easier appendectomy, a transcolonic ureteral reimplantation that is technically simple and reinforced plication of the ileocecal junction. This procedure was performed in 70 patients (ages 27 to 85 years) with followup ranging between 3 and 24 months. There have been 5 hospitalizations for urinary tract infections or gastrointestinal complications. Open surgical revision (4%) has been necessary for incontinence in 1 case, for a redundant ileal limb and difficult catheterization in 1, and for ureteral stenosis in the mid portion of the left ureter in 1. A revision procedure is pending for inadequate reservoir volume. Endoscopic meatotomy of ureterocolonic junction strictures has been necessary in 2 cases. All patients are continent day and night with easy catheterization of volumes ranging between 400 and 800 cc. The modified Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because of a low complication and revision rate, and an excellent continence rate.     

A comparative study of the ileal conduit, Kock pouch and modified Indiana pouch

Between July 1986 and July 1988, 55 urinary diversions were performed, including 18 ileal conduits, and 12 Kock and 25 Indiana pouch procedures. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function and short-term followup, including rehospitalizations, revisions and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch groups. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit were 5 hours 27 minutes and 1,290 cc versus 5 hours 30 minutes and 1,201 cc for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all 3 groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no rehospitalizations or revisions, the Indiana pouch group had 4 rehospitalizations and no revisions, and the Kock pouch group had 9 rehospitalizations and 3 revisions. The day and nighttime continence rate was 100% in the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be accomplished safely and effectively in any patient requiring an ileal conduit.     

A comparative study of the ileal conduit, Kock pouch and modified Indiana pouch

Between July 1986 and July 1988, 55 urinary diversion procedures were performed: 18 ileal conduits, 12 Kock pouches and 25 Indiana pouches. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function, and short-term followup including re-hospitalizations, revisions, and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch patients. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit was 5:27 hours and 1290 cc's versus 5:30 hours and 1201 cc's for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all three groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no re-hospitalizations or revisions; the Indiana pouch group had four re-hospitalizations and no revisions; the Kock pouch group had nine re-hospitalizations and three revisions. The day and night-time continence rate was 100% in both the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, has similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be just as safely and effectively accomplished in any patient requiring an ileal conduit.     

改良Indiana膀胱成形术的疗效观察

目的：探讨改良Ｉｎｄｉａｎａ膀胱成形术的临床效果。方法：１９９１年９月￣１９９７年１２月对１２例膀胱癌患者施行了膀胱全切加改良Ｉｎｄｉａｎａ膀胱成形术。结果：随访８个月￣７年，除２例死于肿瘤复发及肺部转移外，１０例２均健在。结论：该术式具有良好可控性、低压、大容量、抗反流、容易插管等优点，是膀胱替代及尿液分流较为理想的术式之一。     

改良Indiana膀胱成形术的疗效观察(附12例报告)

目的 :探讨改良 Indiana膀胱成形术的临床效果。方法 :1991年 9月～ 1997年 12月对 12例膀胱癌患者施行了膀胱全切加改良 Indiana膀胱成形术。结果 :随访 8个月～ 7年 ,除 2例死于肿瘤复发及肺部转移外 ,10例患者均健在。结论 :该术式具有良好可控性、低压、大容量、抗反流、容易插管等优点 ,是膀胱替代及尿液分流较为理想的术式之一。     

Present experience with the Indiana pouch

Summary The Indiana pouch was developed as a modification of the Glichrist procedure in 1984. The need for full detubularization of the reservoir was recognized early and was achieved by an ileal patch on the cecal reservoir or by an antimesenteric incision of the cecal segment with folding and transverse closure, the efferent limb and continence mechanism were modified to promote ease of catheterization and improved continence. These modifications gave markedly better results with lower reoperation rates. A group of 81 patients with a minimum of 2 years of follow-up are reported herein. The most recent modification uses absorbable GIA and TA55 staples to detubularize and close the reservoir. This stapling technique has been employed in 20 patients and has resulted in decreased operating times without any significant increase in complications. In its current form, the Indiana pouch meets all the criteria for a satisfactory continent cutaneous reservoir and has a favorable reoperation rate as compared with other pouches.     

Continence mechanisms of the Indiana pouch

The Indiana pouch is a large capacity, lowpressure continent urinary reservoir. The mechanism of continence in the Indiana pouch has been shown to be the result of several factors, including the natural resistance of the ileocecal valve, resistance produced by the plication or tapering of the ileal efferent limb, and peristalsis of the ileum. Continence in urinary diversions is reviewed with special emphasis on the mechanisms of continence in the Indiana pouch.     

改良Sigma直肠膀胱术

目的评价改良Sigma直肠膀胱术式可控性尿流改道的临床疗效。方法在2002年1月～2004年6月对5例膀胱癌患者采用改良Sigma直肠膀胱术式。折叠乙状结肠约25cm后全层切开，再缝合成低压袋，顶端固定在骶岬处，两输尿管末端合并，从低压袋上方引入，与切除了一小片段的肠黏膜匙形吻合再植。结果全组所有患者尿控率100％，无尿失禁、未发生明显酸碱平衡紊乱，肾功能损害及上尿路感染、上尿路结石、吻合口狭窄等并发症。结论改良Sigma直肠膀胱术并发症低、尿控效果好，术后生活质量较高，是一种快速、安全并简单易行的尿流改道方法。     

可控性回结肠膀胱术的技术改进及临床应用

对可控性回结肠膀胱术技术进行改进，并应用于１５例病人。男性１３例，女性２例，平均年龄５３岁。其中１２例因多发性或浸润性移行细胞癌，３例因晚期神经源性膀胱而行膀胱全切除术。经技术改进后的Ｉｎｄｉａｎａｐｏｕｃｈ操作简便，安全，无术中并发症。手术时间平均７小时，输血平均６００ｍｌ。术后上尿路功能良好，插管方便，贮尿囊容量４００ｍｌ，顺应性好，最大充盈压力平均３．２０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），病人生活质量提高。     

Colonic adenocarcinoma and stones in an Indiana pouch

We report on a 63-year-old woman with adenocarcinoma and stones in an Indiana pouch. Adenocarcinoma of an Indiana pouch is extremely rare. To our knowledge, only four cases with adenocarcinoma in an Indiana pouch have been reported.     

Laparoscopic cecostomy tube placement in an Indiana pouch

A cecostomy tube is normally placed in an Indiana pouch for drainage and irrigation in the postoperative period. A clinical dilemma occurs when the cecostomy tube fails or is dislodged in the early postoperative period. We present the laparoscopic replacement of a cecostomy tube in the immediate postoperative period.     

The mechanisms of continence in the Indiana pouch: a video-urodynamic study

The ileocecal reservoir (Indiana pouch) is a large volume, low pressure continent reservoir well suited for urinary diversion. The mechanism of continence is believed to be the result of several factors, including the natural ileocecal valve resistance, resistance produced by the plication of the ileal segment and normal peristalsis of the ileum. We report the results of a video-urodynamic study in patients with an Indiana pouch, aimed at establishing the factors that contribute to continence and their relative significance. Video-urodynamic studies clearly demonstrate that continence in this type of urinary reservoir is dependent upon a synergism of the aforementioned factors in combination with the low intraluminal pressure of the detubularized bowel. Video-urodynamic studies offer an objective demonstration of the reservoir dynamics and its continence mechanisms, and provide an insight into the possible etiology of incontinence. Such studies also offer an objective means for critical comparison of the different continent urinary reservoirs.     

改良Indiana膀胱术(附5例报告)

目的：探讨改良Indiana膀胱术的适应证、手术方法并对疗效进行评估。方法：对5例膀胱癌患者施行全膀胱切除加改良Indiana膀胱术。结果：５例患者均获得满意的疗效，自行导尿顺利，随访６－３０个月，均尿控满意，排尿次数５－６次／昼，１－３次／夜。其中４例行造影，新膀胱呈球形，容量４００－５００ml，无输尿管尿液反液。结论：改良Ｉndiana膀胱术具有操作容易，贮尿囊低压容量大，抗返流机制可靠，尿控满意，并发症少的优点，值得在临床推广。     

Indiana pouch in female patients with spinal cord injury

OBJECTIVE: We assessed the results of a continent urinary diversion (Indiana pouch) in seven women with severe neurogenic urinary incontinence. PATIENTS AND METHODS: There were seven patients (mean follow-up 28 months), in five of whom a complete Indiana pouch was created. In two the bladder was augmented with the Indiana pouch, the bladder neck was closed and an umbilical stoma was created. In three cases the appendix served as outlet whereas in the other patients a continent catheterisable stoma was created by means of a tapered terminal ileum. RESULTS: All the patients were dry (the stoma was continent) and could catheterise themselves while sitting in a wheelchair. There was one complication (bleeding) immediately postoperatively that needed reintervention. The late complications were acceptable: in one patient a stone had to be removed from the pouch and there was a stenosis of the stoma in two others. There was no hyperchloraemic acidosis. CONCLUSION: The Indiana pouch is a safe and effective method for neurogenic incontinence when all available pharmacological treatments and clean intermittent catheterisation have failed. It has little impact on the body image, and the independence and social reintegration of the woman is improved.     

可控性回结肠膀胱术远期疗效观察

评价可控性回结肠膀胱手术的远期疗效。方法对２０例回结肠膀胱术术后病人的可控性、尿动力学、血清电解质、肾功能等进行随访观察。结果２０例随访６－１１８个月，平均６２个月。白天可控率１００％，夜间可控率９５％。贮尿囊容量３８０－６６０ｍｌ，平均５８０ｍｌ。