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Miami Pouch: A Simple Technique for Efficient Continent Cutaneous Urinary Diversion.

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The Miami pouch (MP) offers a reliable continent urinary diversion for eligible patients after radical cystectomy. This technique provides a viable alternative to ileal conduits, preserving body image without external appliances.

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Area of Science:

  • Urology
  • Surgical Techniques
  • Reconstructive Surgery

Background:

  • Radical cystectomy necessitates urinary diversion.
  • Orthotopic neobladder is not suitable for all patients.
  • Ileal conduit is a common but appliance-dependent diversion.

Purpose of the Study:

  • To present a contemporary series of Miami pouch (MP) reconstructions.
  • To provide a detailed technical description and video of the MP procedure.
  • To promote wider adoption of the MP technique.

Main Methods:

  • Retrospective chart review of 15 patients undergoing MP between January 2016 and December 2017.
  • MP construction using terminal ileum and right colon with a catheterizable tube.
  • Primary outcome: continence assessed by absence of leakage between clean intermittent self-catheterization (CISC) at 4-hour intervals.

Main Results:

  • 15 patients underwent MP with a 13.3% rate of 30-day Clavien III complications.
  • At 39 months median follow-up, 13/15 patients achieved continence.
  • No significant renal function changes, stenosis, or CISC difficulties were observed.

Conclusions:

  • The Miami pouch is a reliable cutaneous continent urinary diversion for patients unsuitable for orthotopic neobladder.
  • MP offers an alternative to ileal conduit, potentially improving body image and quality of life.
  • Patient counseling should include MP as an option for those desiring a diversion without external appliances.