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Late Complications of the Modified Indiana Pouch

1994; Lippincott Williams & Wilkins; Volume: 151; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(17)34940-6

1527-3792

Timothy G. Wilson, José Moreno, Alan C. Weinberg, Thomas E. Ahlering,

Orthopedic Surgery and Rehabilitation

No AccessJournal of Urology1 Feb 1994Late Complications of the Modified Indiana Pouch Timothy G. Wilson, Jose G. Moreno, Alan Weinberg, and Thomas E. Ahlering Timothy G. WilsonTimothy G. Wilson , Jose G. MorenoJose G. Moreno , Alan WeinbergAlan Weinberg , and Thomas E. AhleringThomas E. Ahlering View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)34940-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The modified Indiana pouch is currently an accepted and widely used form of continent cutaneous urinary diversion. However, results of long-term followup and potential late complications are still being established. We report our experience with 130 modified Indiana pouches performed between September 1987 and September 30, 1991. In 16 patients (12%) late complications developed between 1 and 16 months after the pouch procedure. Ureteral obstruction developed in 9 of these patients (7%), including bilateral obstruction in 4. Balloon dilation with or without incision of ureteral strictures in 6 patients resulted in an 83% failure rate, while ureteral reimplantation was successful in 91% (10 of 11 cases). Reservoir dysfunction was the late complication in the remaining 7 patients. Urodynamic evaluation was essential in determining appropriate treatment for incontinence with either replication of the ileal segment or pouch augmentation with an ileal patch. Of the 16 late complications 56% occurred in patients who received between 3,000 and 6,500 rad of pelvic radiation before the urinary diversion. We conclude that the modified Indiana pouch is a successful form of urinary diversion with an acceptable complication rate. Ureteral balloon dilation with or without endoscopic incision of ureteral strictures has not been successful. However, patients can usually undergo successful ureteral reimplantation via an extraperitoneal approach with minimal morbidity. Previously radiated patients are at higher risk for complications and require shorter ureteral tunnels to avoid stricture, in addition to an ileal patch at initial construction. References 1. : Modified Indiana pouch. J. Urol.1991; 145: 1156. Link, Google Scholar 2. : Ectopia vesicae (absence of the anterior walls of the bladder), operation, and subsequent death. Lancet1851; 2: 370. Google Scholar 3. : Urinary diversion. Brit. J. Urol.1990; 66: 113. Google Scholar 4. : Bladder substitution after pelvic evisceration. Surg. Clin. N. Amer.1950; 30: 1511. Google Scholar 5. : A 20-year experience with ileal conduits: the fate of the kidneys. J. Urol.1979; 122: 154. Google Scholar 6. : Evaluation of 144 cases of ileal conduits in adults. Eur. Urol.1988; 15: 89. Google Scholar 7. : Continent urinary diversion. J. Urol.1989; 141: 1323. Link, Google Scholar 8. : Construction of a substitute bladder and urethra. Surg., Gynec. & Obst.1950; 90: 752. Google Scholar 9. : Indiana continent urinary reservoir. : 1987: 1136. Google Scholar 10. : The continent cecal urinary reservoir. In: Bladder Reconstruction and Continent Urinary Diversion. chapt. 15 In: . Edited by . Chicago: Year Book Medical Publishers1986: 209. Google Scholar © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBochner B, Karanikolas N, Barakat R, Wong D and Chi D (2018) Ureteroileocecal Appendicostomy Based Urinary Reservoir in Irradiated and Nonirradiated PatientsJournal of Urology, VOL. 182, NO. 5, (2376-2381), Online publication date: 1-Nov-2009.Wiesner C, Stein R, Pahernik S, Hähn K, Melchior S and Thüroff J (2018) Long-Term Followup of the Intussuscepted Ileal Nipple and the In Situ, Submucosally Embedded Appendix as Continence Mechanisms of Continent Urinary Diversion With the Cutaneous Ileocecal Pouch (Mainz Pouch I)Journal of Urology, VOL. 176, NO. 1, (155-160), Online publication date: 1-Jul-2006.AHLERING T, GHOLDOIAN G, SKARECKY D, WEINBERG A and WILSON T (2018) SIMPLIFIED TECHNIQUE WITH SHORT AND LONG-TERM FOLLOWUP OF CONVERSION OF AN ILEAL CONDUIT TO AN INDIANA POUCHJournal of Urology, VOL. 163, NO. 5, (1428-1431), Online publication date: 1-May-2000.Ahlering T (2018) Editorial: Urinary Tract ReconstructionJournal of Urology, VOL. 157, NO. 2, (475-475), Online publication date: 1-Feb-1997.Terai A, Ueda T, Kakehi Y, Terachi T, Arai Y, Okada Y and Yoshida O (2018) Urinary Calculi as a Late Complication of the Indiana Continent Urinary Diversion: Comparison with the Kock Pouch ProcedureJournal of Urology, VOL. 155, NO. 1, (66-68), Online publication date: 1-Jan-1996.Navon J, Wong A, Weinberg A and Ahlering T (2018) Comparative Study of Postoperative Complications Associated With Modified Indiana Pouch in Elderly Versus Younger PatientsJournal of Urology, VOL. 154, NO. 4, (1325-1328), Online publication date: 1-Oct-1995.Janknegt R, Heesakkers J, Weil E and Baeten C (2018) Electrically Stimulated Gracilis Sphincter (Dynamic Graciloplasty) for Treatment of Intrinsic Sphincter Deficiency: A Pilot Study on Feasibility and Side EffectsJournal of Urology, VOL. 154, NO. 5, (1830-1833), Online publication date: 1-Nov-1995.Tarter T, Kawachi M and Wilson T (2018) Entero-Pouch Fistula: A Rare Complication of Right Colon Continent Urinary DiversionJournal of Urology, VOL. 154, NO. 2, (364-366), Online publication date: 1-Aug-1995. Volume 151Issue 2February 1994Page: 331-334 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsurinary diversionureteral obstructionMetricsAuthor Information Timothy G. Wilson More articles by this author Jose G. Moreno More articles by this author Alan Weinberg More articles by this author Thomas E. Ahlering More articles by this author Expand All Advertisement PDF downloadLoading ...