What is an Indiana Pouch?

Marlene Garcia

An Indiana pouch is a type of reservoir surgically created as a urinary diversion system for people whose bladder is removed due to cancer or other illnesses. The surgery uses segments of the large and small bowel to create a container to hold urine and a drainage tube to empty the pouch. The pouch serves as a substitute bladder inside the body to collect urine filtered by the kidneys.

If a patient no longer has a bladder due to cancer or other illness, surgery may be necessary to create an Indiana pouch.
If a patient no longer has a bladder due to cancer or other illness, surgery may be necessary to create an Indiana pouch.

During Indiana pouch surgery, a doctor alters the position of the urethra so it points in a downward motion into the new urine reservoir. This prevents urine from backing up into the kidneys and causing infection. The pouch is made from a section of large intestine and connected to a piece of small intestine that protrudes out the side of the stomach. This outer piece is called a stoma.

Individuals who experience frequent urinary problems may have an increased risk of developing bladder cancer.
Individuals who experience frequent urinary problems may have an increased risk of developing bladder cancer.

A catheter can be inserted into the stoma so the pouch can be drained, which is necessary every four to six hours. The stoma contains a one-way valve that keeps urine from leaking and opens when the catheter is inserted. When the pouch is not being emptied, the stoma can be covered with a small piece of sterile bandage.

An Indiana pouch is made from a section of the large intestine.
An Indiana pouch is made from a section of the large intestine.

One advantage of Indiana pouch surgery over other types of continent urinary diversion is the absence of an external bag to hold urine. The patient does not have to worry about odor or leakage if the bag is emptied on a regular schedule. No special clothing is needed to hide the stoma because it is small and not visible through most clothes. The risk of infection is also low if the catheter is kept clean and used properly.

Disadvantages of Indiana pouch surgery include its complex nature. The amount of time required to create the pouch is greater than in some other types of bladder replacement surgeries. Mucus can plug the stoma because segments of the bowel are used to form the reservoir, and catheters need to be replaced every four to six weeks. If a patient fitted with an Indiana pouch wants to swim, the stoma must be sealed to prevent water from coming into contact with the drainage tube.

Complications of Indiana pouch procedures include the potential for urinary tract infections. The urethras can also become blocked if infection occurs, requiring another operation to clear them. Some patients report leakage from the stoma, but this usually goes away as the capacity of the pouch expands over time.

During Indiana pouch surgery, a doctor will alter the position of the urethra to prevent urine from backing up into the kidneys.
During Indiana pouch surgery, a doctor will alter the position of the urethra to prevent urine from backing up into the kidneys.

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