title: Indiana pouch in children: a 15-year experience.
abstract: OBJECTIVE
  We report our experience with the Indiana pouch (continent urinary reservoir) in 12 consecutive children over the last 15 years and report their follow-up.
  
  
  METHODS
  Twelve consecutive children, who underwent the continent urinary reservoir procedure in the form of an Indiana pouch, were prospectively enrolled in the study. All consecutive children who were referred to our service with multiple failed surgeries for exstrophy-epispadias repair, cloacal exstrophy, genitourinary rhabdomyosarcoma with residual disease in the trigonal area not amenable to partial cystectomy, and neuropathic bladder with nephrogenic metaplasia were included over the period 1997-2012. All these children were offered the same form of bladder substitution (Indiana pouch) as described by the Indiana group many years ago. Postoperative care was on a fixed protocol, and follow-up details recorded over the years. They were followed up for dry interval with clean intermittent catheterisation, social acceptance, and early and late complications.
  
  
  RESULTS
  Out of these 12 patients (7 males and 5 females), eight patients had exstrophy-epispadias with multiple failed operations carried out elsewhere, cloacal exstrophy (2), residual rhabdomyosarcoma in the trigonal area with incontinence following chemotherapy (1), and neuropathic bladder with recurrent diffuse neoplastic polyposis (1). In the follow-up period of 1-15 years (median 24 months) all the patients had a dry interval of 4 h or more with clean intermittent catheterisation. One patient had wound dehiscence during the postoperative period and another required stomal revision 1 year after initial surgery.
  
  
  CONCLUSIONS
  The Indiana pouch is a reliable, safe, and effective form of bladder substitution. It can be reconstructed in a wide range of lower urinary tract disorders. In the vast majority of children with multiple failed surgical procedures for exstrophy-epispadias, the Indiana pouch is a safe, reliable, and reproducible procedure to provide a socially acceptable quality of life with a dry interval of 4 h.
authors.affiliation: Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110044, India. Electronic address: sujitchowdhary@hotmail.com.
authors.forename: Sujit K
authors.initials: SK
authors.lastname: Chowdhary
authors.affiliation: Advanced Pediatric Centre, Department of Pediatric Surgery, PGIMER, Sector 12, Chandigarh 160012, India.
authors.forename: Katargadda L N
authors.initials: KL
authors.lastname: Rao
authors.affiliation: Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110044, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Kandpal
authors.affiliation: Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110044, India.
authors.forename: Anupam
authors.initials: A
authors.lastname: Sibal
authors.affiliation: Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110044, India.
authors.forename: Rajendra N
authors.initials: RN
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003106:Colon; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014570:Urologic Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*
keywords: Children; Cloacal exstrophy; Failed exstrophy repair; Indiana pouch