Indiana Pouch Requires Intermittent Catheterization
Yes, an Indiana pouch absolutely requires intermittent catheterization for proper functioning and maintenance. This continent urinary reservoir is specifically designed to be emptied via clean intermittent catheterization (CIC) through a stoma, typically every 4-6 hours.
Understanding the Indiana Pouch
The Indiana pouch is a type of continent urinary diversion created using segments of the terminal ileum and right colon. Key features include:
- Complete detubularization of the colonic segment
- Reinforced plication of the ileocecal junction to create continence
- Creation of a catheterizable stoma, often at the umbilicus or lower abdomen
- Storage capacity of approximately 400-800 cc 1, 2
Catheterization Requirements
Frequency and Volume Management
- Intermittent catheterization should occur every 4-6 hours to prevent overfilling
- The bladder should not be allowed to fill beyond 500 mL to maintain proper function
- Catheterization stimulates normal physiological filling and emptying cycles 3
Technique
- Clean technique must be used to minimize infection risk
- Patients must be taught proper self-catheterization skills
- The stoma must be kept clean and accessible
Complications of Inadequate Catheterization
Failure to perform regular catheterization of an Indiana pouch can lead to serious complications:
- Urinary tract infections (UTIs): A major risk with any urinary diversion
- Pouch overdistention: Can lead to leakage, incontinence, or pouch damage
- Stomal stenosis: May develop if regular catheterization isn't maintained
- Stone formation: Occurs in approximately 5-6% of Indiana pouch patients 4
- Difficult catheterization: May require surgical revision in some cases 5, 2
Long-term Management Considerations
The Indiana pouch has shown excellent long-term outcomes when properly managed:
- Continence rates: 90-100% when properly constructed and maintained 5, 4
- Surgical revision rates: Approximately 10-11% compared to 22% with Kock pouches 4
- Stone formation: Lower rates than other continent diversions 4
- Patient satisfaction: High when patients can maintain the catheterization schedule
Patient Education and Support
Successful management requires:
- Thorough education on self-catheterization techniques
- Understanding of the importance of regular emptying
- Recognition of potential complications
- Access to appropriate catheterization supplies
- Regular follow-up with healthcare providers
Conclusion
The Indiana pouch provides excellent continence and quality of life, but this is entirely dependent on the patient's ability and willingness to perform regular intermittent catheterization. Without catheterization, the pouch cannot function as intended and serious complications will develop. All patients with an Indiana pouch must commit to lifelong intermittent catheterization as the cornerstone of their urinary management.