Indiana Pouch

An Indiana pouch creates a new place for pee to go when your urinary bladder either no longer works the way it should or has been removed.

It’s a common type of continent urinary diversion. This means that the pouch (reservoir) stores pee in your body until you remove it. You remove pee from the Indiana pouch with a drainage tube (catheter), which you place through a tunnel in your belly.

Your healthcare provider may recommend an Indiana pouch if you have:

• Bladder cancer
• Bladder exstrophy
• Interstitial cystitis/bladder pain syndrome (IC/BPS)
• Decompensated bladder

It consists of parts of your large intestine (colon) and small intestine. The pouch connects to the skin of your belly through a tunnel made of your small intestine. The opening on your belly wall (stoma) is normally small and slightly raised.

Experts at the Indiana University School of Medicine developed the Indiana pouch surgical procedure in the 1980s. That’s where it gets its name. Other names for an Indiana pouch include:

• Urinary reservoir
• Continent cutaneous pouch
• Continent cutaneous diversion
• Continent cutaneous reservoir

How does an Indiana pouch work?

Unlike other forms of urinary diversion where pee is always leaking out (incontinent diversion), the Indiana pouch is a continent diversion, which holds pee inside your body. It’s similar to a healthy bladder. Throughout the day, you insert a catheter into a stoma in your belly to drain pee from the pouch. Once the pouch is empty, you can remove the catheter.

Is it an ostomy?

Yes. An ostomy is a surgery that creates a small opening (stoma) in your belly for pee or poop to come out. Your surgeon will create a stoma so you can drain pee from your Indiana pouch.

The stoma in an Indiana pouch is often quite small — about the size of a dime or nickel — and rises above the rest of your skin. Your surgeon can place it on the right side of your belly or near your belly button. It doesn’t need a urostomy bag over it to control leaks.

What are the benefits and risks?

The main benefit of an Indiana pouch is that you can control when you pee. You don’t need to use a bag outside of your body. It may also be possible to put the stoma below your waistline. This makes it easier to hide under your pants if you’re not wearing a shirt.

But an Indiana pouch also has some risks. These may include:

• Higher risk of urinary tract infections (UTIs)
• Higher risk of kidney stones
• Mucus in your stoma that clogs catheters
• Leaky stoma
• Narrow stoma that makes it hard to drain the pouch

Rarely, the stoma may also reabsorb certain electrolytes and other waste products that normally leave your body when you pee. This can cause electrolyte imbalances in your blood.

What happens during Indiana pouch surgery?

Your healthcare team will give you specific instructions on how to prepare. These include when to stop eating and drinking before the procedure, whether you should stop taking any medications and how to do bowel prep to clear your colon.

Before the procedure, your care team will:

• Explain the procedure to you.
• Check your general health and take your vitals (temperature, pulse and blood pressure).
• Ask if you have any allergies.
• Ask if you’re pregnant or could be pregnant.

During Indiana pouch surgery, your healthcare providers will:

1. Give you general anesthesia so you aren’t awake for the procedure and won’t feel any pain.
2. Likely remove your entire bladder. They may perform this as an open surgery or a minimally invasive surgery.
3. Remove sections of your intestines and form them into an Indiana pouch, which has a ball-like shape.
4. Create a small stoma out of your small intestine.
5. Attach the pouch to your ureters, which are the tubes that had connected your kidneys to your bladder.
6. Reattach the ends of your intestines.
7. Close the incisions with stitches.

The procedure takes about five to eight hours to perform.

What is the success rate?

The Indiana pouch success rate is good. Most people are happy with their results. But during the first three to six months after surgery, it can take some time to adjust to using the pouch and for the pouch to expand.

There’s also a risk of the stoma or channel narrowing over time, which can make it hard to drain your pouch. You may need more procedures to correct this issue.

How long will it take for me to feel better?

It may take several months to recover after your healthcare providers remove your bladder and create an Indiana pouch. You’ll also need time to adjust to the changes in your body. Your providers will help you adapt to these changes. For example, they’ll teach you how to drain and irrigate your pouch.

How often do you drain it?

Most people drain their Indiana pouch about six times per day. You may need to empty it more often if you drink a lot of fluids.

How do I drain it?

Follow these steps to drain (catheterize) your Indiana pouch:

1. Wash your hands with soap and water.
2. Remove the bandage or covering over your stoma.
3. Use a clean paper towel to remove moisture or mucus from your stoma.
4. Apply a lubricating jelly all over the catheter.
5. Position yourself so pee can flow into a nearby toilet or container.
6. Slowly insert the catheter into your stoma.
7. Adjust the catheter if you feel any resistance. This may include adjusting the angle and taking a deep breath to help relax your muscles.
8. Adjust the catheter to make sure your pouch is completely empty.
9. Slowly remove the catheter and throw it away.
10. Clean the lubricating jelly off your stoma.
11. Wash your hands.
12. Put a new bandage or covering over your stoma to keep it clean and prevent infection.

How do I irrigate it?

Your stoma consists of a piece of your small intestine, which creates mucus. Rinsing (irrigating) your Indiana pouch flushes mucus so that pee drains out easily. It also helps prevent complications like UTIs and pouch stones.

Follow these steps to irrigate your Indiana pouch:

1. Catheterize your Indiana pouch.
2. Draw up to 60 milliliters of saline solution into a syringe.
3. Insert the syringe into the catheter. Slowly press down on the syringe to release the saline solution into your pouch.
4. Remove the syringe and drain the saline solution into a bag or container. If you can’t drain it, reposition the catheter or place an additional 60 milliliters of solution into your pouch.
5. Repeat steps 3 through 4 until the drained solution looks clear.
6. Remove the syringe from the catheter, remove the catheter from your stoma and throw the catheter away.
7. Clean the lubricating jelly off your stoma.
8. Wash your hands.
9. Put a new bandage or covering over your stoma.

Most people irrigate their Indiana pouch once or twice per day. You may need to irrigate it more often if your stoma creates a lot of mucus.

When should I call my healthcare provider?

Contact your healthcare provider right away if you have:

• Signs of infection, including fever, chills, pus around your incisions and cloudy pee
• Trouble catheterizing or irrigating your Indiana pouch
• Blood in your pee (hematuria)
• Pain in your belly or between your ribs and hips (flank)

What is the difference between an Indiana pouch and a neobladder?

They’re similar because they both create new ways to store and remove pee from your body. And like an Indiana pouch, a neobladder also consists of parts of your intestines. But a neobladder connects to your urethra, so pee will come out of your body the same way it did before the procedure. With an Indiana pouch, you must drain pee from a stoma in your belly with a catheter.