When the bladder is removed or cannot function effectively, a new method for urine storage and elimination becomes necessary. This surgical intervention is known as urinary diversion, creating an alternative pathway for urine to exit the body. Such procedures are essential to maintain kidney health and overall well-being, as urine backup can lead to serious complications including infections, stone formation, and kidney damage.
Understanding the Indiana Pouch
An Indiana pouch is a surgically constructed internal reservoir designed to store urine within the body after the natural bladder has been removed or is severely dysfunctional. This type of procedure is a continent cutaneous urinary diversion, meaning it allows for internal urine storage and controlled emptying, without the need for an external collection bag. The Indiana pouch is created using a segment of the large intestine, specifically the cecum and a portion of the ascending colon, along with a small segment of the ileum (a part of the small intestine).
The ureters, which are the tubes that transport urine from the kidneys, are then connected to this newly formed pouch. A small opening, called a stoma, is created on the abdominal wall, typically in the lower right abdomen, through which a portion of the ileum is brought to the surface. This stoma serves as the access point for emptying the pouch. The Indiana pouch offers an alternative to other urinary diversion methods, such as an ileal conduit, which requires a continuously draining external bag.
How the Indiana Pouch Functions
The pouch is designed to hold urine, preventing continuous leakage. A key aspect of its function is the continence mechanism, which relies on the ileocecal valve, a natural one-way valve located between the small and large intestines. This valve, incorporated into the pouch’s design, prevents urine from leaking out through the stoma.
To empty the pouch, individuals perform clean intermittent catheterization. This involves inserting a thin, flexible tube, known as a catheter, through the stoma and into the pouch. Urine then drains through the catheter. After the pouch is empty, the catheter is removed. This process is typically performed several times a day on a set schedule, allowing for controlled and convenient urine elimination without the need for an external bag.
Living with an Indiana Pouch
Living with an Indiana pouch involves a routine of self-care and management to ensure proper function and hygiene. A primary aspect of care is regular self-catheterization, typically every 3 to 6 hours during the day, and at least once at night to prevent overfilling and potential complications. Initially, individuals may need to empty the pouch more frequently, every 1-2 hours, as it gradually stretches to hold more urine, eventually reaching a capacity of around 13-16 ounces (approximately 400-500 ml).
Stoma hygiene is important, involving regular cleaning of the small opening on the abdomen. Since the pouch is made from intestinal tissue, it continues to produce mucus, which can accumulate and potentially block the catheter. To manage this, daily irrigation of the pouch with saline solution may be necessary, flushing out the mucus. Staying well-hydrated by drinking plenty of water helps thin the mucus, making it easier to drain. While occasional leaks can occur, especially during the initial adjustment period, many individuals find that wearing a small pad over the stoma offers sufficient protection. Maintaining a normal lifestyle is achievable, with many individuals able to engage in exercise and travel by planning and carrying necessary supplies.
Indications for an Indiana Pouch
The most common reason for this procedure is bladder cancer, particularly when the cancer is invasive and necessitates a radical cystectomy (complete removal of the bladder). In these cases, the Indiana pouch provides an internal storage solution for urine.
Beyond cancer, other medical conditions can also necessitate an Indiana pouch. These include severe forms of neurogenic bladder, where nerve damage prevents the bladder from properly storing or emptying urine. Congenital anomalies, such as bladder exstrophy, which involve a birth defect where the bladder is exposed outside the body, can also be an indication. Additionally, chronic inflammatory conditions that severely damage the bladder or severe trauma to the urinary tract may lead to the need for this type of urinary diversion. The decision to create an Indiana pouch is made after careful consideration of the patient’s overall health and specific urinary system challenges.