We conclude that every patient has the right to have continent diversion. An orthotopic bladder approach should be considered first, and if it is not feasible, then the Indiana pouch could be a suitable alternative with no additional complications, unless this procedure is contraindicated.
Waleed Fadlalla, MD, Abdlmaksoud Mohamed, MD, Mohamed Salama, MD, Amr Attia, MD; National Cancer Institute
INTRODUCTION: The main problems with ileal conduit (IC) urinary diversion are urinary incontinence and complications of urinary stoma, which severely affect the quality of life of patients. An Indiana pouch provides urinary continence and may have fewer complications of urinary stoma.
AIM: To compare the long-term effects of the Indiana pouch and IC following radical cystectomy in patients with carcinoma of the urinary bladder
PATIENTS AND METHODS: This study was conducted for 80 patients who underwent radical cystectomy for carcinoma of the urinary bladder. Indiana pouch urinary diversion was done for 40 patients and compared with a similar number of patients with IC urinary diversion between 2009 and 2013.
RESULTS: Six patients (7.5%) developed early or late stomal complications. One patient with an Indiana pouch (2.5%) complained of stomal stenosis and difficult catheterization, and five patients with IC (12.5%) complained of stomal complications (one patient had parastomal hernia, one patient had stomal bleeding, and three patients had skin complications). Twenty-three patients (28.75%) showed morphological renal back pressure changes and deterioration: 8 patients (20%) in the Indiana group and 15 patients (37.5%) in the IC group. Sixteen patients (20%) showed improvement in pelvicalyceal dilatation that was noted preoperatively: 10 patients (25%) in the Indiana group and 6 patients (15%) in the IC group. Thirty-eight patients (47.5%) showed a stable picture of the pelvicalyceal system as in the preoperative assessment. The mean ± standard deviation (SD) serum creatinine level was 1.24 ± 0.7 mg/dL, whereas the blood urea level was 36.7 ± 10 mg/dL.
CONCLUSION: We conclude that every patient has the right to have continent diversion. An orthotopic bladder approach should be considered first, and if it is not feasible, then the Indiana pouch could be a suitable alternative with no additional complications, unless this procedure is contraindicated.
Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org