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Indiana pouch in children: a 15-year experience
Sujit K Chowdhary1, Katargadda L N Rao2, Deepak K Kandpal1
1Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110044, India.
Insights
The Indiana pouch (continent urinary reservoir) offers a reliable solution for children with complex lower urinary tract issues. This study shows it provides a socially acceptable quality of life with a 4-hour dry interval.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Continent urinary diversion is crucial for managing complex lower urinary tract disorders in children.
- The Indiana pouch is a well-established technique for bladder substitution.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of the Indiana pouch in pediatric patients.
- To assess outcomes in children with challenging urological conditions, including failed previous surgeries.
Main Methods:
- A prospective study of 12 consecutive children undergoing Indiana pouch creation between 1997 and 2012.
- Patients had conditions such as exstrophy-epispadias, cloacal exstrophy, rhabdomyosarcoma, or neuropathic bladder.
- Follow-up focused on continence, catheterization intervals, social acceptance, and complications.
Main Results:
- All 12 patients achieved a minimum 4-hour dry interval with clean intermittent catheterization.
- The primary indications included complex exstrophy-epispadias repair failures (8 patients).
- Minor complications included one instance of wound dehiscence and one stomal revision.
Conclusions:
- The Indiana pouch is a safe, reliable, and effective bladder substitute for diverse pediatric lower urinary tract anomalies.
- It offers a reproducible method for improving quality of life in children with previously failed surgical interventions.
- The procedure facilitates social acceptance and provides predictable continence.
Objective:
We report our experience with the Indiana pouch (continent urinary reservoir) in 12 consecutive children over the last 15 years and report their follow-up.
Material And Methods:
Twelve consecutive children, who underwent the continent urinary reservoir procedure in the form of an Indiana pouch, were prospectively enrolled in the study. All consecutive children who were referred to our service with multiple failed surgeries for exstrophy-epispadias repair, cloacal exstrophy, genitourinary rhabdomyosarcoma with residual disease in the trigonal area not amenable to partial cystectomy, and neuropathic bladder with nephrogenic metaplasia were included over the period 1997-2012. All these children were offered the same form of bladder substitution (Indiana pouch) as described by the Indiana group many years ago. Postoperative care was on a fixed protocol, and follow-up details recorded over the years. They were followed up for dry interval with clean intermittent catheterisation, social acceptance, and early and late complications.
Results:
Out of these 12 patients (7 males and 5 females), eight patients had exstrophy-epispadias with multiple failed operations carried out elsewhere, cloacal exstrophy (2), residual rhabdomyosarcoma in the trigonal area with incontinence following chemotherapy (1), and neuropathic bladder with recurrent diffuse neoplastic polyposis (1). In the follow-up period of 1-15 years (median 24 months) all the patients had a dry interval of 4 h or more with clean intermittent catheterisation. One patient had wound dehiscence during the postoperative period and another required stomal revision 1 year after initial surgery.
Conclusions:
The Indiana pouch is a reliable, safe, and effective form of bladder substitution. It can be reconstructed in a wide range of lower urinary tract disorders. In the vast majority of children with multiple failed surgical procedures for exstrophy-epispadias, the Indiana pouch is a safe, reliable, and reproducible procedure to provide a socially acceptable quality of life with a dry interval of 4 h.
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