LATE COMPLICATIONS OF THE MODIFIED INDIANA POUCH

The modified Indiana pouch is currently an accepted and widely used fo rm of continent cutaneous urinary diversion. However, results of long- term followup and potential late complications are still being establi shed. We report our experience with 130 modified Indiana pouches perfo rmed between September 1987 and September 30, 1991. In 16 patients (12 %) late complications developed between 1 and 16 months after the pouc h procedure. Ureteral obstruction developed in 9 of these patients (7% ), including bilateral obstruction in 4. Balloon dilation with or with out incision of ureteral strictures in 6 patients resulted in an 83% f ailure rate, while ureteral reimplantation was successful in 91% (10 o f 11 cases). Reservoir dysfunction was the late complication in the re maining 7 patients. Urodynamic evaluation was essential in determining appropriate treatment for incontinence with either replication of the ileal segment or pouch augmentation with an ileal patch. Of the 16 la te complications 56% occurred in patients who received between 3,000 a nd 6,500 rad of pelvic radiation before the urinary diversion. We conc lude that the modified Indiana pouch is a successful form of urinary d iversion with an acceptable complication rate. Ureteral balloon dilati on with or without endoscopic incision of ureteral strictures has not been successful. However, patients can usually undergo successful uret eral reimplantation via an extraperitoneal approach with minimal morbi dity. Previously radiated patients are at higher risk for complication s and require shorter ureteral tunnels to avoid stricture, in addition to an ileal patch at initial construction.