From the Guidelines
An Indiana pouch catheterizable channel imaging study is essential for evaluating the structure and function of an Indiana pouch urinary diversion, and it should be performed using contrast material instilled through the catheterizable stoma into the pouch, followed by radiographic imaging to assess for proper filling, emptying, and to detect any complications such as strictures, leaks, or stones 1.
Importance of Imaging Study
The imaging study is crucial for diagnosing problems with the Indiana pouch, which is created from a segment of the large intestine to form a reservoir for urine after bladder removal, with a continent valve mechanism allowing for catheterization rather than external collection.
Procedure Details
The procedure typically involves:
- Catheterizing the stoma with a 12-14 French catheter
- Instilling 150-300 mL of diluted contrast material
- Taking multiple images during filling and emptying phases
Patient Preparation and Aftercare
Patients should:
- Arrive with a full bladder
- Temporarily discontinue blood thinners prior to the procedure
- Increase fluid intake to help flush the contrast material after the study
- Monitor for signs of infection such as fever or increased pain
Diagnostic Value
The imaging study is valuable for detecting complications such as:
- Strictures
- Leaks
- Stones And for assessing the overall structure and function of the Indiana pouch, allowing for timely and effective management of any issues that may arise 1.
From the Research
Indiana Pouch Catheterizable Channel Imaging Study
- The Indiana pouch is a widely accepted and often used form of continent urinary diversion, with various studies examining its long-term complications and reoperation rates 2, 3, 4, 5.
- Complications related to the efferent limb, such as incontinence, stomal stenosis, and difficult catheterization, are common in patients with an Indiana pouch 2.
- Imaging studies may be used to evaluate the catheterizable channel and detect potential complications, such as ureteral anastomotic strictures, pouch stones, and perforations 2, 3.
- The use of absorbable staples to detubularize and close the reservoir has been shown to decrease operating times without increasing complications 4.
- Recent studies have reported comparable complication rates for the Indiana pouch to other urinary diversions, with a significant portion of complications occurring during the first postoperative year 5.
Complications and Reoperation Rates
- Long-term complications of the modified Indiana pouch are mostly related to the efferent limb, with reoperations often due to stomal stenosis 2.
- Perioperative and long-term surgical complications for the Indiana pouch and similar continent catheterizable urinary diversions are extremely variable between studies, but ranges between 1-32% and 6-69%, respectively 3.
- Common long-term surgical risks include ureteral stenosis, problems with the catheterizable channel, and the treatment of pouch or other urinary calculi 3.
- Patients undergoing continent catheterizable reservoir urinary diversion appear to have comparable complication rates to other urinary diversions published in the literature 5.