Full Answer
How does an Indiana pouch work?
The Indiana Pouch is a continent urinary reservoir, meaning no bag is necessary to store the urine outside the body. Instead of a bag, the right colon is removed from the rest of the bowel and re-fashioned into a pouch that can hold 600mL of fluid (equivalent to about two soda cans).
What is an Indiana catheter?
Make an Appointment An Indiana pouch is a surgically-created reservoir used to internally store and eliminate urine. This allows patients who have had their urinary bladders removed to empty their urine with an intermittent catheter.
How long does Indiana pouch last?
The surgery is estimated to last around 6-8 hours. Afterward, you would stay in the hospital for 3-4 days, maybe longer. After the surgery, a physical therapist will help you achieve moderate movements to avoid developing blood clots.
How often do you empty an Indiana pouch?
Patients drain urine from the pouch by putting a catheter into a stoma every four to six hours. The stoma is located in your right lower abdomen (self-catheterization). This process is not painful.
Can you swim with an Indiana pouch?
You can swim or be in the water while wearing your pouching system. Remember, your pouching system is water resistant and is designed not to leak with the proper seal. Water will not harm or enter your stoma. Check your pouch seal.
What is another name for an Indiana pouch?
What is an Indiana pouch (continent diversion)? After the bladder is removed, the surgeon typically uses reconstructive surgery to create a different way for the patient to store and pass urine out of the body. One option for this is called a continent diversion, which is also called an Indiana pouch reservoir.
How do you take care of an Indiana pouch?
As an overview, here are the things you should be doing to take care of your Indiana pouch:Drink plenty of water to avoid infections and mucus built-up.Never force a catheter in! ... Lubricate the catheter before insertion or use a pre-lubricated catheter to avoid irritating the pouch channel.More items...
How do you pee with a neobladder?
You are able to use a catheter to empty your neobladder if necessary. This may be necessary if you find it hard to urinate normally. When that happens, you will need to insert a catheter (tube) into the urethra to release the urine from your neobladder. (This happens in a small number of people who have a neobladder.)
How long does it take to recover from bladder surgery?
It will take 6 weeks from the date of surgery to fully recover from your operation. This can be divided into two parts -- the first 2 weeks and the last 4 weeks. During the first 2 weeks from the date of your surgery, it is important to be "a person of leisure".
What is urinary diversion surgery?
Urinary diversion is a surgical procedure that creates a new way for urine to exit your body when urine flow is blocked or when there is a need to bypass a diseased area in the urinary tract.
Which is better ileal conduit or neobladder?
Urinary function is worse in neobladder patients compared to ileal conduit patients. Sexual function is better in neobladder patients but causes much more bother. In retrospect, none of the patients regret their choice of urinary diversion.
What is a urinary pouch?
Urostomy pouches are special bags that are used to collect urine after bladder surgery. Instead of going to your bladder, urine will go outside of your abdomen into the urostomy pouch. The surgery to do this is called a urostomy. Part of the intestine is used to create a channel for the urine to drain.
What are the 3 main types of catheters?
There are 3 main types of catheters: Indwelling catheter. Condom catheter. Intermittent self-catheter.
Why would you need a suprapubic catheter?
A suprapubic catheter is used when the urethra is damaged or blocked, or when someone is unable to use an intermittent catheter. The catheter may be secured to the side of your body and attached to a collection bag strapped to your leg.
What is the difference between a catheter and a Foley?
Foley catheters (developed by Dr. Foley in the 1930's) are meant for longer term use by patients who are unable to use the toilet themselves. Straight catheters are simply straight tubes (without the balloon feature of a Foley catheter). They are meant for quick drainage of the bladder and not for long term use.
How long does a suprapubic catheter stay in?
The catheter will need to be changed every 4 to 6 weeks. You can learn how to change your catheter in a sterile (very clean) way. After some practice, it will get easier. Your health care provider will change it for you the first time.
Why is it called an Indiana Pouch?
This technique was named after Indiana University, where it was first developed.
How do I know when I need to urinate?
Most people feel abdominal tightness or mild cramps that should not be painful. Instead, it typically feels as uncomfortable as having a full bladd...
Do I have to wear pads or an adult diaper?
No. You should be able to wear regular underwear. Many people also wear a Band-Aid or very small pad to keep the small amount of mucous that the st...
If I have my bladder removed, do I need any other treatments for the cancer, such as chemotherapy or radiation?
Generally, you will not need radiation. Some patients benefit from chemotherapy. We will talk with you about any additional treatment options that...
What is Indiana pouch?
An Indiana pouch is a surgically -created urinary diversion used to create a way for the body to store and eliminate urine for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrophy or who are not continent due to a congenital, neurogenic bladder.
How does Indiana pouch work?
In contrast to other urinary diversion techniques, such as the ileal conduit urinary diversion, the Indiana pouch has the advantage of not using an external pouch adhered to the abdomen to store urine as it is created inside of the body. The urine is drained through a small stoma that is barely visible. This can result in a better body image and broader clothing options. Also, there will not be the worry of an external urostomy appliance coming loose and leaking. The Indiana pouch will require sterile catheters to insert into the stoma to drain the urine every 3-4 hours. To avoid a possible fatal infection, a new sterile intermittent catheter should be used each time and not reused. As with the urostomy appliances, the cost of intermittent catheters can be significant, and both are not usually covered fully by most health insurance plans. Plus, as with the external urostomy appliance, the catheter supply will need to be monitored to see how many appliances are left before ordering more and waiting for them to be shipped. The long term financial costs to the recipient of the Indiana pouch and other urinary diversion techniques are both substantial. Although notably, the Indiana pouch is the most viable option for maintaining a lifestyle similar to prior the surgery because of the ability to move freely from fear of rupturing an external device plus the ability to continue most of the same activities.
How often should you drain urine from an Indiana pouch?
The Indiana pouch will require sterile catheters to insert into the stoma to drain the urine every 3-4 hours. To avoid a possible fatal infection, a new sterile intermittent catheter should be used each time and not reused.
What are the symptoms of urinary diversion?
Also this type of urinary diversion causes immediate metabolic changes that can give a wide range of symptoms from diarrhea, vitamin B12 deficiency, electrolyte abnormalities, hepatic metabolism, and possible bone health deterioration.
How long does it take for a pouch to heal in Indiana?
It can take 6-12 months for your body to adjust to the Indiana pouch.
What is the valve between the small and large intestines?
Since a segment including the large and small intestines is utilized, also included in this new system is the ileocecal valve. This is a one-way valve located between the small and large intestines. This valve normally prevents the passage of bacteria and digested matter from re-entering the small intestine.
How many drainage tubes are there after stoma surgery?
After surgery, patients will have three drainage tubes place while tissues heal: one through the newly created stoma, one through another temporary opening in the abdominal wall into the pouch, and an SP tube (to drain non-specific post-surgical abdominal fluid).
What is an Indiana pouch?
The Indiana Pouch helps you avoid wearing an external urine bag and results in normal bladder control. What to Expect During an Indiana Pouch. Slice. If you have muscle-invasive bladder cancer, your physician will most likely perform a radical cystectomy to treat you. During this surgery, your doctor removes your entire bladder.
How often do urologists perform Indiana Pouches?
institutions who use this procedure the most. Our urologists each perform several Indiana Pouches every month and around 30 to 60 per year—an extremely high amount.
How does a urostomy bag work?
You wear an external urostomy bag (about 3 by 10 inches in size) to catch and store the urine. A urostomy bag is a plastic urine collection pouch. You attach the urostomy bag with adhesive to the outside of your body.
How does urine travel to the bladder?
Your kidneys make your urine. The urine travels to your bladder, which stores it until you urinate. To urinate, you pass the urine through a tube called the urethra and out of your body. During Indiana Pouch surgery: Our urologists build a “new” bladder, or pouch, from your colon tissue.
What to do before bladder removal surgery?
Before your procedure: You undergo an extensive evaluation to make sure you are healthy enough for bladder removal and Indiana Pouch surgery. You complete a bowel preparation to clean out your colon. This bowel prep is similar to one you would complete before a colonoscopy.
Where is the stoma located?
Patients drain urine from the pouch by putting a catheter into a stoma every four to six hours. The stoma is located in your right lower abdomen (self-catheterization). This process is not painful.
Where does urine go during surgery?
The urine travels to your bladder, which stores it until you urinate. To urinate, you pass the urine through a tube called the urethra and out of your body. During Indiana Pouch surgery: Our urologists build a “new” bladder, or pouch, from your colon tissue.
What is an Indiana pouch (continent diversion)?
One option for this is called a continent diversion, which is also called an Indiana pouch reservoir.
How does an Indiana pouch work?
Typically, a patient will empty the pouch every four to six hours using a catheter (a thin, flexible tube) that is inserted through the stoma and into the pouch. This allows urine to flow out of the pouch reservoir and into the toilet. Before and after inserting the catheter into the stoma, patients should wash their hands as well as wash and then dry the stoma and the skin around the stoma. Patients also need to regularly use a syringe to flush out any mucus that collects in or around the stoma.
What are the disadvantages of an Indiana pouch?
If urine is left for too long in the pouch without emptying it, it can cause bacteria to grow and lead to infections.
How does continent diversion work?
To create a continent diversion, the surgeon creates a pouch out of a small part of the patient’s own intestines. The pouch is used to store urine inside the patient’s body until the patient is ready to drain the urine out of the body. One end of the pouch is attached to the ureters, with connection to the kidneys and allows urine to flow into the pouch. The other end of the pouch is connected to a small opening in the patient’s abdomen, which is called a stoma.
Can you return to work after continent diversion?
2 Patients usually have no problem returning to work as usual after they have recovered from surgery, unless they have certain jobs that require strenuous physical activities that may need to be adjusted.
How common is each type of urinary diversion?
One study looked at radical cystectomy cases at Indiana University from 2011 to 2013 and found that out of 233 people, about 60 percent opted for the IC, 24 percent for the NB, and 16 percent for the IP.
What is the Indiana Pouch?
The Indiana Pouch is also known as a continent diversion. The surgeon creates a pouch out of a small part of the person’s own intestines to store urine inside the body. The person empties that pouch every 4-6 hours using a catheter (a thin, flexible tube) that is inserted through the stoma (a small opening in the patient’s abdomen). 2
Meet Jeri and learn why she chose the Indiana Pouch
BladderCancer.net Editorial team member Alina Ahsan connected with Jeri to ask her about her bladder cancer journey. Check out the interview below!
Can you relate?
We are grateful that Jeri is a part of our community and that we can share her story with you. Which parts of Jeri’s journey could you relate to?
How to use a pouch?
A good pouching system should: 1 Stay secure with a good leak-proof seal that lasts for 3 to 7 days 2 Be odor-resistant 3 Protect the skin around the stoma 4 Be nearly invisible under clothing 5 Be easy to put on and take off 6 Allow you to shower or bathe with the pouch on, if you wish to do so
What is the name of the diversion of the continent?
Continent diversion, also called a continent urostomy or continent urinary reservoir
What is an ostomy pouch?
Pouches come in many styles and sizes, and an ostomy nurse can help you choose the best one for your situation and lifestyle. They all have a collection pouch to collect the urinary drainage and an adhesive barrier that sticks to your skin (called a flange, skin barrier, or wafer) and a collection pouch.
How to make an ileal conduit?
To make an ileal conduit, a 6- to 8- inch piece of the lower part of the small intestine (called the ileum) is cut out near where it attaches to the large intestine (colon). The rest of the ileum is then re-connected to the large intestine. The ureters are detached from the bladder and attached to the piece of ileum that was removed. The bladder may or may not be removed. The far end of the piece of ileum is brought through the front of the abdomen wall to form the stoma. The other end is sewn closed to make a pocket that holds the urine inside the body. This surgery is a life-long change. The urine output cannot be controlled and a collection pouch will have to be worn at all times.
Why do you need a pouching system?
The constant flow of urine from the stoma can irritate the nearby skin. The pouching system’s skin barrier is designed to protect the skin from urine and be as gentle to the skin as possible. Depending on the design, you may need to cut a hole out for your stoma, or it may be sized and pre-cut.
What is a conduit for urostomy?
Skin protection is needed; will need a drainable, valve-end pouch that’s adaptable to night drainage. For this type of urostomy, an ileal conduit is made. An ileal conduit is a small pouch that holds urine. It’s surgically created from a small piece of bowel (intestine).
Which part of the intestine produces mucus?
The small intestine produces mucus naturally. The segment of intestine that was used to form the ileal conduit or urine pocket will keep making mucus, too. The mucus will collect in the pouch along with the urine. This is normal.
Who developed the Indiana pouch?
In the 1980s, there were several key developments in the field of urinary diversion that led to the development of the Indiana Pouch. In 1980, Paul Mitrofanoff, MD described continent diversion utilizing a catheterizable appendicovesicostomy. This established what has since been termed “the Mitrofanoff principle.”.
Why choose the Indiana pouch of the neobladder?
I find that the factor that leads patients to choose the Indiana Pouch of the neobladder is the concern for neobladder hypercontinence requiring urethral catheterization. Conversely, the patient perception of being more anatomically intact tends to motivate patients to choose the neobladder over the Indiana Pouch.
What is continent ileocecal reservoir?
Since its creation in 1985 at Indiana University, the continent ileocecal reservoir, or Indiana Pouch, has been a standard urinary diversion option for patients who desire a continent urinary diversion. Indiana University School of Medicine Department of Urology professor emeritus Richard Bihrle, MD was one of the original developers of this technique and has performed over 300 of these surgeries. Below, Bihrle answers some common questions about this procedure.
Who developed the urology technique?
Indiana University School of Medicine Department of Urology professor emeritus Richard Bihrle, MD was one of the original developers of this technique and has performed over 300 of these surgeries. Below, Bihrle answers some common questions about this procedure.
How does a 14-FR catheter feel?
It will feel tighter than one would think it needs to be. The surgeon should feel a gentle pop when passing a 14-Fr soft red rubber catheter (notice the catheter change) across the imbricated valve. I like doing the plication after detubularizing the colon, but before closing it horizontally so that I can actually see the internal side of the valve.
