Very long-term follow-up of Indiana Pouches proves durability.
Indiana Pouch
complications
continent urinary diversion
ileocolonic pouch
Journal
Neurourology and urodynamics
ISSN: 1520-6777
Titre abrégé: Neurourol Urodyn
Pays: United States
ID NLM: 8303326
Informations de publication
Date de publication:
30 Nov 2023
30 Nov 2023
Historique:
revised:
14
11
2023
received:
12
09
2023
accepted:
16
11
2023
medline:
30
11
2023
pubmed:
30
11
2023
entrez:
30
11
2023
Statut:
aheadofprint
Résumé
An 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. In 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. A 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. Two-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.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.
Références
Lee RK, Abol-Enein H, Artibani W, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014;113(1):11-23.
Rowland RG, Mitchell ME, Bihrle R, Kahnoski RJ, Piser JE. Indiana continent urinary reservoir. J Urol. 1987;137:1136-1139.
Monn MF, Kaimakliotis HZ, Cary KC, et al. Short-term morbidity and mortality of Indiana pouch, ileal conduit, and neobladder urinary diversion following radical cystectomy. Urol Oncol Semin Orig Investig. 2014;32:1151-1157.
Månsson W, Davidsson T, Könyves J, Liedberg F, Månsson Å, Wullt B. Continent urinary tract reconstruction: the Lund experience. BJU Int. 2003;92:271-276.
Maffezzini M, Campodonico F, Capponi G, Manuputty E, Gerbi G. Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch. Surg Oncol. 2012;21:191-195.
Salom EM, Mendez LE, Schey D, et al. Continent ileocolonic urinary reservoir (Miami pouch): the University of Miami experience over 15 years. Am J Obstet Gynecol. 2004;190:994-1000.
Torrey RR, Chan KG, Yip W, et al. Functional outcomes and complications in patients with bladder cancer undergoing robotic-assisted radical cystectomy with extracorporeal Indiana pouch continent cutaneous urinary diversion. Urology. 2012;79:1073-1078.
Castillo OA, Aranguren G, Campos-Juanatey F. Reservorio urinario continente cateterizable de Indiana. Actas Urológicas Españolas. 2014;38:413-418.
Nieuwenhuijzen JA, de Vries RR, Bex A, et al. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results off our different diversions. Eur Urol. 2008;53:834-844.
Holmes DG, Thrasher JB, Park GY, Kueker DC, Weigel JW. Long-term complications related to the modified Indiana pouch. Urology. 2002;60:603-606.
Wilkin M, Horwitz G, Seetharam A, et al. Long-term complications associated with the Indiana pouch urinary diversion in patients with recurrent gynecologic cancers after highdose radiation. Urol Oncol Semin Orig Investig. 2005;23:12-15.
Myers JB, Lenherr SM. Perioperative and long-term surgical complications for the Indiana pouch and similar continent catheterizable urinary diversions. Curr Opin Urol. 2016;26:376-382.
Madersbacher S, Schmidt J, Eberle JM, et al. Long-term outcome of ileal conduit diversion. J Urol. 2003;169:985-990.
Kälble T, Hofmann I, Riedmiller H, Vergho D. Tumor growth in urinary diversion: a multicenter analysis. Eur Urol. 2011;60(5):1081-1086.