Objective: We assessed the results of a continent urinary diversion (Indiana pouch) in seven women with severe neurogenic urinary incontinence.
Patients And Methods: There were seven patients (mean follow-up 28 months), in five of whom a complete Indiana pouch was created. In two the bladder was augmented with the Indiana pouch, the bladder neck was closed and an umbilical stoma was created. In three cases the appendix served as outlet whereas in the other patients a continent catheterisable stoma was created by means of a tapered terminal ileum.
Results: All the patients were dry (the stoma was continent) and could catheterise themselves while sitting in a wheelchair. There was one complication (bleeding) immediately postoperatively that needed reintervention. The late complications were acceptable: in one patient a stone had to be removed from the pouch and there was a stenosis of the stoma in two others. There was no hyperchloraemic acidosis.
Conclusion: The Indiana pouch is a safe and effective method for neurogenic incontinence when all available pharmacological treatments and clean intermittent catheterisation have failed. It has little impact on the body image, and the independence and social reintegration of the woman is improved.
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