Life after bladder removal... Let's talk about Indiana Pouch

Imagine that due to some medical condition, perhaps cancer, your entire bladder has to be surgically removed. When that happens, you may be left wondering, 'Oh my God, how am I going to urinate now?' It's a daunting question. But don't worry. There are many great solutions for that in modern medicine today. Today, we're going to talk about one such special solution. It's called the 'Indiana Pouch.'

Simply put, what is this Indiana Pouch?

The Indiana Pouch is a small pouch inside your body that stores and releases urine. In other words, it is an artificial bladder that replaces your bladder. Your urinary bladder is a small organ that collects and stores urine. When it is removed for any reason, the Indiana Pouch takes over.

This involves surgically removing your bladder (a `cystectomy`) and creating this pouch in its place. The special thing about this method is that it doesn't constantly leak urine like some other methods of urination. Just like your old bladder, this pouch also collects urine. When you need to, you can insert a tube (a `catheter`) through a small opening (a `stoma`) made in your abdomen to drain the collected urine. Once the pouch is empty, you can remove the tube.

In what cases is this surgery necessary?

A doctor will often recommend removing your bladder and creating an Indiana Pouch in the following cases:

• Bladder cancer: This surgery is most often performed as a treatment for bladder cancer.
• 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 disorders: In rare congenital conditions such as `Bladder exstrophy`.
• Other severe medical conditions: In conditions that severely affect the bladder, such as interstitial cystitis, and that do not respond to other treatments.

What is this pouch made of?

You might be wondering what this is made of. Don't be surprised, this pouch is made using a part of your own body. That is, this urine bag is made from a part of your large intestine . Also, the small opening (the `stoma`) where the urine tube is inserted is made from a part of your small intestine .

How do you prepare before surgery?

Before this surgery, you will need to meet with your doctor several times. He or she will explain the procedure to you and your other options. He or she will check your general health, discuss the procedure, and answer any questions you may have.

• Tell your doctor about all the medications you are taking: Whether you are taking a prescription or over-the-counter medication, you should tell your doctor about all the medications you are taking. You may also want to tell your doctor about any herbal or Ayurvedic products you are taking. Things like aspirin, painkillers, and blood thinners can increase your risk of bleeding. Do not stop taking any medications without first asking your doctor.
• Tell us about your allergies: Tell us about any allergies you have. This includes allergies to medications, skin cleansers like iodine, latex, and foods.
• Instructions about food and drink: You will be instructed not to eat or drink anything after midnight the night before surgery. If you need to take any medication, you will be told to take it with a sip of water. It is very important to follow these instructions exactly.

Let's learn about how the surgery is performed.

Because this is a somewhat complex surgery, it is performed by a team of specialists. This team usually includes a urologist, an anesthesiologist, and a nursing staff.

First, the anesthesiologist will put you under general anesthesia. This means you will be put into a deep sleep so that you will not feel any pain. Then, the specialist will remove your 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 several small incisions.

After removing your bladder, your doctor will take parts of your bowel and use them to create a new, ball-shaped urinary pouch. Then, the two ureters from your kidneys will be connected to this new pouch. Now, urine from your kidneys will flow directly into this pouch. They will also reconnect the two parts of your bowel that were cut. This will ensure that your digestive process will not be interrupted .

This entire surgery usually takes between 6 and 8 hours.

How to use and maintain the Indiana Pouch?

This is the most important part of your new lifestyle. It may be a little strange at first, but after a while you will get used to it.

The correct way to catheterize urine from a pouch

1. First, wash your hands thoroughly with soap.

2. Remove the plaster or gauze around your stoma (opening).

3. Wipe away any moisture or mucus around the stoma with a clean paper towel.

4. Apply a good amount of lubricating jelly to the catheter you were given. You can use a type recommended by your doctor or something like Vaseline™.

5. Now slowly insert the tube into the stoma. Sometimes it may feel a little tight. If this happens, take a deep breath, relax your muscles a little, pull the tube out a little, and try inserting it again at a different angle.

6. Once the tube is inserted into the pouch, urine will start to come out. Let the urine collect in a toilet or container. Wait until the pouch is completely empty.

7. When the urine stops flowing, remove the tube very slowly . If you pull it out too quickly, some urine may spill out.

8. Discard the used tube.

9. Clean around the stoma and apply a new piece of gauze or bandage to prevent infection.

10. Wash your hands thoroughly again.

Most people have to urinate about 6 times a day. If you drink a lot of fluids, like water, you'll have to urinate more often. You may even have to get up at night to urinate.

How do you irrigate the Indiana Pouch?

Because the stoma is made from a part of the intestine, it naturally produces mucus. When this mucus builds up, it can block the tube, cause infections, and cause kidney stones. So you need to rinse the pouch with saline solution once or twice a day. The hospital will show you how to do this.

What are the advantages and risks of this method?

Like any medical procedure, this one has both benefits and risks.

Recovery and when to seek medical advice

It may take several months to fully recover and adjust to your new lifestyle after this surgery. During that time, your medical team will provide you with all the support you need. After a few weeks, you will be able to return to work and do light work.

Are Indiana Pouch and Neobladder the same?

No. Both are bladder replacements, but they work differently. A neobladder is attached directly to your urethra, so you can urinate as you normally would before surgery. However, with the Indiana Pouch, you have to drain urine through a tube placed through a stoma in your abdomen.

Indiana Pouch, cystectomy, stoma, catheter, urinary tract infection, surgery, bladder cancer