What is an Indiana Pouch? Let's learn about this surgery

Perhaps you or someone you know has had to have their bladder surgically removed due to a medical condition. Then, a big question comes to mind: how to release the urine that builds up in the body? Well, one modern solution is the 'Indiana Pouch'. Although this is a bit of a complicated topic, let's talk about it very simply, in a way that you can understand.

Simply put, what is this Indiana Pouch?

An Indiana pouch is a small, surgically created reservoir inside your body that is used to store and remove urine from your body. Think of it like your bladder, which is like a small container that collects and stores urine. When your bladder is removed for any reason (this surgery is called a cystectomy), a new 'urine pouch' needs to be created in its place.

This Indiana pouch is made from your own body parts. That is, it is made from a part of your intestines. The special thing about this is that, unlike some other surgeries that are performed after the bladder is removed, urine can be collected and stored inside this pouch. Exactly like what happens with a bladder.

Then, several times a day, you can insert a small tube (a catheter) through a small opening in your abdomen (we call this a `stoma`) to drain the collected urine. Once the urine is gone , you can remove the tube.

What types of conditions is this surgery performed for?

There are several main reasons why the bladder is usually removed. An Indiana pouch is recommended in the following cases:

• Bladder cancer: This is the most common reason for surgery.
• Bladder muscle dysfunction: Sometimes, due to radiation therapy or nerve damage in the brain and spinal cord (neurogenic bladder), the bladder muscles cannot contract properly and urine cannot be released.
• Congenital bladder deformities (Bladder exstrophy): Some children may be born with certain bladder problems at birth.
• Interstitial cystitis/bladder pain syndrome: A condition that is accompanied by unbearable pain.
• When the bladder is damaged due to other serious medical conditions.

How do you prepare before surgery?

Before this surgery, your doctor will talk to you carefully. He will explain the Indiana Pouch procedure to you and the other options available. He will check your general health, blood pressure, etc.

There are a few things you should definitely tell your doctor at this time:

• Tell your doctor about all the medications you are taking. This includes prescription medications, over-the-counter medications, herbal supplements, and vitamins. Some medications (such as aspirin and blood thinners) can increase bleeding during surgery. Do not stop taking any medications without first asking your doctor.
• Tell us about any allergies you have. That means anything from allergies to medications, certain foods, to latex, etc.
• The doctor advises you not to eat or drink anything after midnight the night before the surgery. You should follow those instructions exactly. If you absolutely must take an essential medication, you may be able to take it with just a sip of water. Ask your doctor about that too.

How the surgery is performed

This is a major surgery that takes between 6 and 8 hours. It involves a urologist, an anesthesiologist, and a nursing staff.

1. Anesthesia: First, the anesthesiologist will put you completely asleep (`general anesthesia`). So you won't feel any pain during the surgery.

2. Bladder removal: Next, the surgeon will remove your entire bladder. This can be done either as an `open surgery`, which involves making a long incision in your abdomen, or as a `laparoscopic or robotic surgery`, which involves making just a few small incisions.

3. Creating the Indiana Pouch: After removing the bladder, the doctor will cut out parts of your large intestine and small intestine and sew a new bladder (pouch) into a ball-shaped structure.

4. Connection: Next, the two tubes that carry urine from the kidneys (`ureters`) are connected to this new pouch. A small opening (`stoma`) is made in the abdomen, allowing it to come out onto the skin. The cut sections of the intestine are reconnected, so your digestive process is not interrupted.

5. Suturing the incisions: Finally, the incisions made during surgery are closed with stitches.

After surgery, you will be taken to a recovery room for a short time. Once you regain consciousness, you will be given medication to control the pain. You will need to stay in the hospital for a few days. During this time, the nursing staff will teach you how to care for and clean your new Indiana pouch.

How to Catheterize and Irrigate an Indiana Pouch

This is the most important thing you should do every day. It may feel a little difficult at first, but after a few days of doing it, it will become very normal.

What are the advantages and disadvantages of this method?

Like any medical procedure, this one has advantages, disadvantages, and risks.

Recovery and when to see a doctor

It may take several months to fully recover from this surgery. It will also take time for your body to adjust to the changes. But your medical team will help you through this. You should be able to return to work or school and do light work within a few weeks.

However, if you have these symptoms, see your doctor immediately:

• Signs of infection: fever, chills, dark urine.
• If it is difficult to insert the catheter or wash the pouch.
• If there is blood in the urine (hematuria) .
• If you experience severe pain in the stomach or the area between the ribs and hips.

A few additional points

Why is this called the 'Indiana' pouch?

This surgical technique was first developed in the 1980s by a group of doctors at Indiana University in the United States. That's why it got its name.

Is this the same as a Neobladder?

Although they are similar, they are not the same. A neobladder is made from the same parts of your bowel. But it is connected to your urethra. So urine flows out the same way it did before surgery. But with an Indiana pouch, a catheter is inserted through a stoma in your abdomen to drain urine.

Your life will change a lot after Indiana Pouch surgery. You will have to get used to new habits. But with these changes, you will have the opportunity to live a more comfortable and better life. Talk openly with your doctor about any questions or concerns you have.