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.