Some remarks on a re-do urinary diversion by converting the ileal conduit to an Indiana pouch

Although the ileal conduit is a wide accepted urinary diversion with a low rate of long way postoperative complications, some patients are not satisfied with the change of body image and the need to wear an external bag inherent to the Bricker's diversion. We report on a patient who underwent cystectomy and Bricker's diversion for bladder cancer which afterwards was converted to an Indiana pouch due to patient preference. The use of the proximal portion of the preexisting ileal conduit facilitated the pouch construction, minimizing the bowel requirement and the need for redoing the ureteral anastomoses. The conversion from ileal-conduit to a catheterizable pouch is technically feasible and involves a better perception of the body image, and a less cumbersome management of the diversion. Before any surgical reconstruction, a realistic discussion with the patient, explaining the potential physical and life-style changes, and problems encountered postoperatively, is the crucial issue.