Very long‐term follow‐up of Indiana Pouches proves durability

Abstract

IntroductionAn Indiana Pouch (IP) is a heterotopic, continent, urinary diversion from an ileocolonic segment. Numerous studies have investigated its long‐term outcomes, albeit none extending beyond a 5‐year follow‐up period. IPs can be used as urinary diversion for benign indications and as such are constructed in typically young patients. As a consequence of their extended lifespan, there is a need for very long‐term (>5 years) IP outcome data and comprehensive complication analysis.Materials and MethodsIn this retrospective cohort study, the data of all patients attending our academic functional urology tertiary referral center for surveillance between 2015 and 2022 after an earlier IP procedure without uro‐oncological indication were analyzed. The primary objective was to identify the prevalence of complications associated with IP, including stomal stenosis, ureter‐pouch stenosis, pouch calculi, stomal leakage, pouch perforation, and parastomal herniation, and to determine the time span between creation of the IP and occurrence of complications.ResultsA cohort of 33 patients (23 female) was analyzed. Median age at IP creation was 38 (range 5–62) years. Median follow‐up was 258 (range 24–452) months. During follow‐up, 22 (67%) patients underwent at least one surgical revision. In total, 45 revision procedures were performed. The estimated mean revision‐free survival was 198 (95%‐CI 144–242) months.ConclusionTwo‐thirds of our IP patients required surgical revision during very long‐term follow‐up. However, the mean revision‐free survival was 198 months. This establishes the IP as a durable and resilient option for urinary diversion, yet underlines the need for lifelong follow‐up as some of these complications and indication were subclinical. These results contribute significantly to patient counseling when discussing different options for urinary diversion, especially at a younger age.

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

“…Despite the Indiana pouch presenting better quality of life outcomes compared to non-continent urinary diversions due to the presence of a catheterizable reservoir, the most commonly reported complications, in the long run, are stomal stenosis, infection, stones and leakage which were mostly related to the efferent limb [68,69]. Nevertheless, the Indiana pouch is still widely used, and long-term follow-ups are available in the literature, including also laparoscopic and robot-assisted approaches [70][71][72].…”