A comparative study of the ileal conduit, Kock pouch and modified Indiana pouch

Between July 1986 and July 1988, 55 urinary diversion procedures were performed: 18 ileal conduits, 12 Kock pouches and 25 Indiana pouches. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function, and short-term followup including re-hospitalizations, revisions, and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch patients. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit was 5:27 hours and 1290 cc's versus 5:30 hours and 1201 cc's for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all three groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no re-hospitalizations or revisions; the Indiana pouch group had four re-hospitalizations and no revisions; the Kock pouch group had nine re-hospitalizations and three revisions. The day and night-time continence rate was 100% in both the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, has similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be just as safely and effectively accomplished in any patient requiring an ileal conduit.