Pouchogram

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What is a pouchogram?

Urinary pouches are an alternative to an ileal conduit, for urine storage and drainage in patients who have undergone cystectomy; these pouches allow urine storage similar to the bladder, do not require a urinary drainage bag, are periodically emptied by either catheterization or voiding, and are therefore sometimes referred to as neo-bladders. They are of two main varieties: cutaneous and orthotopic. Many such pouches have been developed, and the names assigned to the pouches are assigned by the surgeon who developed them or the institution where they were developed. For instance, an “Indiana pouch,” a form of cutaneous continent pouch, was developed at Indiana University in the United States, while a “Studer pouch,” an orthotopic urinary pouch, was developed by Dr. Studer.

It is not possible to detail the many continent pouches that are used in clinical practice currently. General principles are that the pouches are constructed of detubularized bowel and are made to have enough capacity to hold ≈500 ml or more of urine, and the ureters are anastomosed to the pouches. In a cutaneous pouch such as the Indiana pouch, the cecum and ascending colon are often used to form the pouch, and the patient catheterizes the pouch through a stoma made of a segment of the terminal ileum. In an orthotopic pouch, ileum is used to construct the pouch, which is anastomosed to the urethra so that the patient can void per urethra by straining and pushing on the pouch.

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