Indiana Pouch Research Articles

Terminal Patients With Urinary Diversion

To investigate the treatment and nursing care problems related to the type of urinary diversion in terminal patients experienced by the primary healthcare sector. A questionnaire about treatment and nursing care problems related to urinary diversion was sent to general practitioners (GPs) and district nurse units (DNUs) that had been in contact with 1 of 71 patients who died following cystectomy in a 5-year period. The patients had 1 of 3 types of urinary diversion: ileal conduit (IC), Indiana pouch (IP), or Hautmann orthotopic neobladder (NB). Both GPs and DNUs reported significant difference in problems associated with the 3 types of urinary diversion favoring the IC (P = .049 and .025, respectively). However, clinical decisions about urinary diversion types are often based on incontinent versus continent diversions. When divided into continent versus incontinent diversions, the analysis revealed no differences in the number of problems (P = .31 and .052, respectively). Comparing IC and NB alone made the difference even less significant (P = .82 and .23, respectively). It seems that there are no major disadvantages with one type of urinary diversion when compared to the other as perceived by primary healthcare providers. Relevant and thorough information should be provided to GPs and DNUs in order to minimize problems with all forms of urinary diversion.

Retrograde Ureteral and Renal Access in Patients With Urinary Diversion

To present our experience with retrograde ureteral and/or renal access in patients with urinary diversion. Retrograde ureteral access may be indicated for treatment of malignancy, ureteroenteric anastomotic stricture disease, or nephrolithiasis, and, in patients with previous urinary diversion surgery, can be technically challenging. We retrospectively identified patients undergoing attempted retrograde ureteral access after urinary diversion surgery. The demographic information, diversion type, indication for retrograde access, success or failure of access, and intra- and postoperative complications were recorded. From 2003 to 2008, 21 renal units (15 patients) with previous urinary diversion surgery underwent attempted retrograde ureteral access. The indications for retrograde access included treatment of nephrolithiasis in 5, ureteroenteric anastomotic stricture in 9, upper tract filling defects in 3, positive cytology findings in 1, and known upper tract malignancy in 3. We made 28 retrograde access attempts. Of these, 21 (75%) were successful. The success rate for each type of urinary diversion was 90% (9/10) for orthotopic neobladders, 73% (11/15) for ileal conduits, and 33% (1/3) for Indiana pouches. All 6 attempts to access the renal units for ureteroscopic management of suspected upper tract malignancy were successful. The access attempts were less successful in 5 of 10 patients (50%) with anastomotic stricture disease. No complications were reported. Retrograde access in patients with urinary diversion is feasible and safe. The risk of failed access is increased in patients with ureteral anastomotic stricture. The diagnosis and/or treatment of upper tract urothelial carcinoma and stone disease can be readily performed with retrograde ureteroscopic techniques.

Comment je fais une dérivation urinaire continente (poche de Miami) après pelvectomie pour tumeur urologique ou gynécologique

After an anterior or total pelvectomy for a urological or gynecological tumour, it is necessary to restore urinary continence. A urinary continent diversion is the main alternative to a non-continent transileal ureterostomy (Bricker) when a orthotopic ilieal neobladder is not possible. We describe the Miami Pouch (PM or Indiana Pouch) technique, from the selection of candidate patients to forms of aftercare.

Serosa Lined and Tapered Ileum as Primary and Secondary Continence Mechanism for Various Catheterizable Pouches

Incontinence of catheterizable ileocecal pouches with an umbilical stoma using the original Mainz pouch technique can be repaired by a secondary ileal intussusception nipple fixed in the ileocecal valve. In cases of a modified Mainz pouch with ureteral anastomosis to the prevalvular ileal segment another form of troubleshooting is necessary. In 4 of 112 patients (3.6%) with the modified Mainz pouch described by Roth incontinence or stenosis of the catheterizable stoma occurred. A 24 to 30 cm segment of ileum was isolated. The proximal 8 to 10 cm were tapered and seroserosally embedded in the U-shaped 2 x 8 to 10 cm long remainder of the segment. After excising the insufficient efferent limb this ileal segment was anastomosed to the pouch and the umbilicus with tapered ileum acting as the continence mechanism. In a fifth patient such a segment was used for ileocystoplasty with an umbilical stoma after bladder neck closure. At a median followup of 6 months (range 5 to 64) all 5 patients were fully continent with regular, easy self-catheterization via the umbilicus. The introduced method seems to be a promising continence mechanism for various forms of catheterizable pouches, not only for troubleshooting.

Application of the Yang-Monti Channel in Adult Continent Cutaneous Urinary Diversion

To report 8 cases using the Yang-Monti channel with ileum for adult continent cutaneous urinary diversion. From 2004 to 2006, 108 patients underwent urinary diversion, 8 of whom had a continent cutaneous reservoir using the Yang-Monti principle. Channels were created by transversely retubularizing 2 to 3 cm of ileum. Indications, technique, complications, and outcomes, such as continence and ease of channel catheterization, are reported. Five patients underwent a right colon reservoir urinary reconstruction after extirpative surgery. Orthotopic neobladders were not performed, owing to anatomic or oncologic concerns. Two additional patients underwent an augmentation, with 1 undergoing an Indiana pouch revision. All urinary reservoirs but 1 were connected to the umbilicus. Two strictures occurred, which were treated with in-office dilation. Incontinence was identified in 2 patients and successfully treated with dextran microspheres injections. All patients were continent at final follow-up. Seven patients continue to perform intermittent catheterization, and 1 patient is managed with an indwelling catheter, owing to comorbidities. The Yang-Monti channel using ileum is an alternative as a neo-appendicoumbilicostomy in construction of continent cutaneous urinary diversion. The channel is surgically versatile and can be used in the creation of a right colon pouch when the appendix is unavailable.

Common Bile Duct Injury During Urologic Laparoscopy

Iatrogenic injuries to the extrahepatic biliary tract are rare during urologic laparoscopy. A few cases of gallbladder injury have been reported; however, to our knowledge, no instance of common bile duct (CBD) injury during urologic laparoscopy has hitherto been described. Out of 2866 transperitoneal laparoscopic urologic procedures between 1997 and 2007, we present two patients who sustained iatrogenic CBD injury, one during laparoscopic anterior pelvic exenteration and Indiana pouch diversion, and the other during laparoscopic partial nephrectomy. Etiology, management, and preventive strategies are summarized.

CHANGING PARADIGMS IN URINARY DIVERSION AND BLADDER REPLACEMENT SURGERY: EVIDENCE FROM A SYSTEMATIC REVIEW

You have accessJournal of Urology1 Apr 2008CHANGING PARADIGMS IN URINARY DIVERSION AND BLADDER REPLACEMENT SURGERY: EVIDENCE FROM A SYSTEMATIC REVIEW Bhaskar K Somani, Ghulam Nabi, Suzie Wong, Margaret Lyttle, Kofi Atiemo, Gladys McPherson, and James N'Dow Bhaskar K SomaniBhaskar K Somani More articles by this author , Ghulam NabiGhulam Nabi More articles by this author , Suzie WongSuzie Wong More articles by this author , Margaret LyttleMargaret Lyttle More articles by this author , Kofi AtiemoKofi Atiemo More articles by this author , Gladys McPhersonGladys McPherson More articles by this author , and James N'DowJames N'Dow More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60706-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "CHANGING PARADIGMS IN URINARY DIVERSION AND BLADDER REPLACEMENT SURGERY: EVIDENCE FROM A SYSTEMATIC REVIEW." The Journal of Urology, 179(4S), pp. 244–245 © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byLarge M, Katz M, Shikanov S, Eggener S and Steinberg G (2018) Orthotopic Neobladder Versus Indiana Pouch in Women: A Comparison of Health Related Quality of Life OutcomesJournal of Urology, VOL. 183, NO. 1, (201-206), Online publication date: 1-Jan-2010. Volume 179Issue 4SApril 2008Page: 244-245 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Bhaskar K Somani More articles by this author Ghulam Nabi More articles by this author Suzie Wong More articles by this author Margaret Lyttle More articles by this author Kofi Atiemo More articles by this author Gladys McPherson More articles by this author James N'Dow More articles by this author Expand All Advertisement PDF downloadLoading ...

Open Surgical Repair of Ureteral Strictures and Fistulas Following Radical Cystectomy and Urinary Diversion

Open surgery after cystectomy can be a challenge. We report the incidence of postoperative urinary diversion-enteric fistula and ureteral strictures in patients undergoing radical cystectomy, and discuss the diagnosis and management of these complications, including our surgical approach to these patients. We preformed a retrospective review of 553 patients undergoing radical cystectomy and urinary diversion for bladder cancer between April 1999 and January 2007. Patients in whom a ureteral stricture or fistula developed were identified by serial laboratory and imaging evaluations. A chart review was preformed to identify symptoms, time to stricture or fistula development, radiological findings, type of diversion, estimated blood loss and whether the original anastomosis was stented. Management and outcomes were assessed. Of 553 patients reviewed ureteral stricture developed in 41 (7.4%) with a mean followup of 20.2 months (range 1 to 98). Strictures developed in 11% (31 of 272) of the orthotopic ileal neobladder, 2.5% (6 of 236) of ileal conduit and 8% (4 of 45) of Indiana pouch cases. Open repair led to an overall success rate of 87%. Urinary diversion-enteric fistula developed in 12 (2.2%) of the 553 patients with a mean followup of 28.4 months (range 3 to 94), all of whom had undergone orthotopic neobladder diversion. No patient had recurrence after surgical repair of the fistula. Open revision remains the gold standard management for ureteral strictures and urinary diversion-enteric fistulas occurring after radical cystectomy. The addition of the chimney modification to the orthotopic neobladder facilitates surgical repair.

Urinary Diversions after Cystectomy: The Association of Clinical Factors, Complications and Functional Results of Four Different Diversions

PurposeWe present a single institute experience of the four most widely used diversions after cystectomy in 281 patients, with an evaluation of the association between clinical factors, complication rates, functional results, and metabolic complications. Materials and methodsBetween 1990 and 2005, 281 consecutive cystectomies were performed at our institute. Four different diversions were offered: an ileal conduit according to Bricker (IC; 118 patients), an Indiana pouch (IP; 51 patients), and orthotopic diversions after cystectomy/neobladder (N; 62 patients), or sexuality-preserving cystectomy and neobladder (SPCN; 50 patients). ResultsForty-four percent developed early complications: IC 48%, IP 43%, N 42%, and SPCN 38%. High ASA score was the only variable significantly associated with early major complications (ASA 1 vs. 3: HR, 0.32; 95%CI, 0.14–0.72). Late complication rate was 51% with fewer complications in the IC group, IC 39%, IP 63%, N 59%, and SPCN 60% (HR, 0.32; 95%CI, 0.14–0.72), which was explained by fewer uncomplicated urinary tract infections (one third of all late complications) in the IC group. There were no differences in experienced late major complications. We found no significant association between tumour stage, ASA, age, preoperative radiotherapy, gender, and diversion-related complication rates.Complete daytime and nighttime continence, respectively, was achieved in 96% and 73% after IP, 90% and 67% after neobladder, and 96% and 67% after SPCN. Metabolic changes were found in 24% of the patients: 21% after IC, 26% after IP, and 28% after orthotopic diversion (neobladder and SPCN combined); low vitamin B12 was measured in 23%, 15%, and 15% respectively. ConclusionsCystectomy with any subsequent diversion remains a procedure with considerable morbidity. High ASA score was associated with more early complications. Orthotopic diversions provide good functional results, but at the cost of more late complications compared with ileal conduits. We found no evidence that age, ASA score, positive lymph nodes, extravesical tumour growth, or previous radiotherapy were contraindications per se for any diversion.

Tubulovillous adenoma in an Indiana pouch urinary diversion managed by endoscopic resection

We present a case of a tubulovillous adenoma in an Indiana pouch managed by endoscopic resection. A 66-year-old male underwent a cystectomy with creation of an Indiana pouch urinary diversion for invasive small cell carcinoma of the bladder. Seven years following his initial surgery, the patient noted several episodes of gross hematuria. The evaluation revealed a 2.5 cm tubulovillous adenoma with high-grade dysplasia within the Indiana pouch. The patient had significant comorbidities precluding an open operative procedure. He underwent en endoscopic resection of the tumor, and subsequently has been managed with surveillance pouchoscopy, biopsies, and fulguration every 3 months.

Colonic adenocarcinoma in an Indiana pouch successfully treated by endoscopic mucosal resection

We report the case of a 76-year-old woman who developed a colonic adenocarcinoma and a stone in an Indiana pouch 15 years after the urinary diversion. The colonic adenocarcinoma was treated endoscopically and we were able to preserve the Indiana pouch. To our knowledge, this is the sixth case of colonic adenocarcinoma in an Indiana pouch.

Percutaneous Cystolithotomy of Large Urinary-Diversion Calculi Using a Combination of Laparoscopic And Endourologic Techniques

Patients with urinary diversions are at higher risk for bladder urolithiasis. Often, the stone burden is large, necessitating open stone removal. We describe our technique for removing such stones using a combination of laparoscopic and endourologic instrumentation. With the patient in the dorsal lithotomy position or supine, cystoscopy is performed via the native urethra or catheterizable stoma, respectively. With the urinary reservoir distended with normal saline, percutaneous access is obtained under direct vision with a 10-mm trocar introduced through the scar of the previous suprapubic cystostomy. A laparoscopic entrapment bag is introduced through the trocar, into which the calculi are manipulated. The bag is delivered percutaneously through the trocar site with subsequent removal of the trocar. A 30F Amplatz renal dilator sheath (Cook Urological, Spencer, IN) is introduced directly into the bag. An ultrasonic lithotrite passed through a nephroscope is utilized to fragment and evacuate the calculi. Closure of the neocystotomy is not performed. A drainage catheter is left in for 7 days. This procedure has been successful in eight consecutive patients, six with bladder augmentations, one with a bladder reconstruction with appendicovesicostomy, and one with an Indiana pouch. All calculi were radiopaque, having a mean linear size of 4.1 cm (range 1.5-7.0) cm. Several patients had multiple stones. The mean operating room time was 123 minutes (range 48-228 minutes). Two patients had concomitant ureteroscopy with laser lithotripsy for ureteral calculi. All were rendered stone free with one procedure and were discharged within 23 hours after surgery. There were no immediate or delayed complications. Our technique of percutaneous cystolithotomy utilizing laparoscopic and endourologic instrumentation is safe and effective for the removal of large calculi from urinary diversions. It is well tolerated, allows complete stone removal in a single sitting, and obviates an open procedure.

Adenocarcinoma in an Indiana Pouch on PET-CT

We report the PET-CT appearance of adenocarcinoma in an Indiana pouch in a patient with a history of squamous cell carcinoma of the cervix diagnosed 17 years ago. As a part of her treatment regimen, an Indiana pouch was constructed. The patient was recently found to have a mass in the diversion pouch after presenting with hematuria, and subsequent biopsy confirmed moderately differentiated adenocarcinoma.

Comparison of the Complications and Urodynamic Parameters for Orthotopic Bladder Substitution with using Ileocolic or Ileal Segments after Radical Cystectomy

Purpose: The objective of this study was to compare the complications and urodynamic parameters of the patients who underwent orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy for treating invasive bladder cancer. Materials and Methods: Between January 1990 and April 2006, 260 patients with invasive bladder cancer underwent radical cystectomy and construction of the urinary diversion; ileal conduit, indiana pouch, ileocolic neobladder, ileal neobladder were all done at St. Mary's Hospital. The mean age of the patient was 61.8 years (range: 46-86). The ratio of male and female was 88%/12%. Forty nine patients received an orthotopic ileocolic neobladder and 45 patients received an orthotopic ileal neobladder. The complications and urodynamic parameters were compared in both groups. Results: The orthotopic ileocolic neobladder after radical cystectomy for treating invasive bladder cancer has been performed between 1990 and 1996 and the orthotopic ileal neobladder has been performed between 1996 and 2006. Ileocolic neobladder related complications developed in 10 patients; neobladder leakage in 1 (2%), neobladder rupture in 1 (2%), stricture of the ureteroenteric anastomosis site in 4 (8.2%), and stricture of the urethral anastomosis site in 4 (8.2%). Ileal neobladder related complications developed in 11 patients; ureteroenteric stricture in 7 (15.5%), stricture of the urethral anastomosis site in 3 (6.6%) and acute pyelonephritis in 1 (2.2%). The results of the mean maximal flow rate and mean postvoid residual volume were better in the ileal neobladder group than those in the ileocolic neobladder group. Conclusions: There were no significant differences in complications between ileocolic neobladder and ileal neobladder. The maximal uroflow and residual urine volume of the ileal neobladder were superior to those of the ileocolic neobladder on urodynamic study. (Korean J Urol 2007; 48:494-499)

A Multimodal Perioperative Plan for Radical Cystectomy and Urinary Intestinal Diversion: Effects, Limits and Complications of Early Artificial Nutrition

We evaluated the effects of early parenteral and enteral postoperative nutritional support on the restoration of normal bowel function, on the protein depletion that follows cystectomy and on observed complications. Immediate parenteral nutrition was initiated after surgery. It was progressively shifted to the enteral route through a needle catheter jejunostomy inserted at surgery. A total of 28 patients with a mean age of 74.2 years (range 55 to 82) were enrolled into the study. Disease was pathologically confined to the bladder in 22 patients, locally advanced in 3 and extravesical in 3. Urinary diversions included an ileocolonic pouch in 15 patients and an orthotopic ileal reservoir in 13. Of the 28 patients 15 (53.6%) completed the protocol, whereas 13 (46.4%) did not. Median time to peristalsis and spontaneous passage of flatus was postoperative day 2 (range 2 to 5) and median time to normal diet resumption was postoperative day 4 (range 3 to 8). No significant differences were observed between patients who completed the protocol and those who did not with regard to the restoration of normal bowel function, and total protein, serum albumin and lymphocyte count. Minor complications were observed in 9 patients and major complications developed in 4. Early postoperative artificial nutrition did not affect the return of bowel function or postoperative protein depletion. Different strategies for more effective nutritional support will be explored in further studies.

Complications in laparoscopic radical cystectomy: The South American experience with 59 cases

In this study, we have gathered the second largest series yet published on laparoscopic radical cystectomy in order to evaluate the incidence and cause of intra and postoperative complication, conversion to open surgery, and patient mortality. From 1997 to 2005, 59 laparoscopic radical cystectomies were performed for the management of bladder cancer at 3 institutions in South America. Twenty nine patients received continent urinary diversion, including 25 orthotopic ileal neobladders and 4 Indiana pouches. Only one case of continent urinary diversion was performed completely intracorporeally. Mean operative time was 337 minutes (150-600). Estimated intraoperative blood loss was 488 mL (50-1500) and 12 patients (20%) required blood transfusion. All 7 (12%) intraoperative complications were vascular in nature, that is, 1 epigastric vessel injury, 2 injuries to the iliac vessels (1 artery and 1 vein), and 4 bleedings that occurred during the bladder pedicles control. Eighteen (30%) postoperative complications (not counting mortalities) occurred, including 3 urinary tract infections, 1 pneumonia, 1 wound infection, 5 ileus, 2 persistent chylous drainage, 3 urinary fistulas, and 3 (5%) postoperative complications that required surgical intervention (2 hernias - one in the port site and one in the extraction incision, and 1 bowel obstruction). One case (1.7%) was electively converted to open surgery due to a larger tumor that precluded proper posterior dissection. Two mortalities (3.3%) occurred in this series, one early mortality due to uncontrolled upper gastrointestinal bleeding and one late mortality following massive pulmonary embolism. Laparoscopic radical cystectomy is a safe operation with morbidity and mortality rates comparable to the open surgery.

Simplified Indiana pouch with multiple teniamyotomies

Objectives To describe a retrospective review of a single-institution, single-surgeon (M.G.) experience with 44 simplified Indiana pouch with multiple teniamyotomies without detubularization and reconfiguration. Methods From April 1999 to May 2003, 44 patients underwent radical cystectomy and continent urinary diversion with a simplified Indiana pouch technique using teniamyotomies without detubularization and reconfiguration. The tenia was sectioned across the whole width and deepened as far as the submucosal layer, with 2 to 3 cm between each teniamyotomy. The efferent tract of the reservoir was prepared using the appendix. If it was unsuitable, an ileum invagination nipple fixed in the ileocecal valve was constructed. Results The mean follow-up was 3 years (range 1 to 5). Continence was excellent for 40 patients (91%); in 4 patients (9%), daytime incontinence was reported. The urodynamic studies showed an average pressure at 350 mL of capacity of 19.6 cm H 2O (range 15.1 to 25.5). The average pressure at maximal capacity (400 to 600 mL) was 32.3 cm H 2O (range 28.5 to 35). Long-term complications occurred in 15 patients (34%), with a mean onset of 13.4 months postoperatively. Conclusions Our experience showed that a modified Indiana pouch with multiple teniamyotomies has a good capacity with low internal pressure and good continence. Thus, even with the comparable results of other continent pouch models, our modified Indiana pouch is a valid alternative because of its simplicity to perform.

152 INVITED Innovations in radical cystectomy

We introduce the operative technique of laparoscopic radical cystectomy and orthotopic ileal neobladder with a Studer limb performed completely intracorporeally.The procedure was performed in 1 man and 1 woman. Using a 6 port transperitoneal approach, radical cystectomy in the female patient and radical cystoprostatectomy in the male patient were completed laparoscopically with the urethral sphincter preserved. Bilateral pelvic lymphadenectomy was done. A 65 cm. segment of ileum 15 cm. from the ileocecal junction was isolated, and ileo-ileal continuity was restored using Endo-GIA staplers (U.S. Surgical, Norwalk, Connecticut). The distal 45 cm. of the isolated ileal segment were detubularized, maintaining the proximal 10 cm. segment intact as an isoperistaltic Studer limb. A globular shaped ileal neobladder was constructed and anastomosed to the urethra. Bilateral stented ureteroileal anastomoses were individually performed to the Studer limb. All suturing was done exclusively using free-hand laparoscopic techniques and the entire procedure was completed intracorporeally. An additional case is described of Indiana pouch continent diversion in which the pouch was constructed extracorporeally.Total operative time for laparoscopic radical cystectomy and orthotopic neobladder was 8.5 and 10.5 hours, respectively, with a blood loss ranging from 200 to 400 cc. Hospital stay was 5 to 12 days and surgical margins of the bladder specimen were negative in each case. Both patients with orthotopic neobladder had complete daytime continence. Postoperative renal function was normal and excretory urography revealed unobstructed upper tracts. During followup ranging from 5 to 19 months 1 patient died of metastatic disease, while the other 2 are doing well without local or systematic progression.Laproscopic radical cystectomy and orthotopic ileal neobladder performed completely intracorporeally are feasible.

LAPAROSCOPIC RADICAL CYSTECTOMY IN THE FEMALE

We detail the technique of completely intracorporeal laparoscopic radical cystectomy in the female patient, which has previously not been well described in the literature. Additionally, perioperative and short-term oncological outcome data are presented. Since 2000, 11 female patients underwent laparoscopic radical cystectomy for bladder carcinoma. Data were collected with respect to patient demographics, perioperative outcomes and short-term oncological followup. Mean patient age was 66 years (range 42 to 80) and the mean body mass index was 25 (range 17 to 34). Mean total operative time was 8.5 hours (range 6.5 to 10.5), including an average radical cystectomy time of 2 to 2.5 hours. Estimated blood loss was 489 cc (range 150 to 1,000). Reconstructive procedures were an ileal conduit in 8 patients, Studer orthotopic neobladder in 2 and continent Indiana pouch in 1. Mean hospital stay was 6 days (range 5 to 12). No case was converted to open surgery. Complications occurred in 4 patients, including internal hernia requiring laparotomy 19 days postoperatively, deep vein thrombosis with pulmonary embolism, dehydration and urinary tract infection in 1 each. At a median followup of 7.1 months (range 1 to 19) 8 patients (73%) had no evidence of disease, 1 (9%) had metastasis and 2 (11%) had died. Laparoscopic radical cystectomy in the female is technically efficacious. Our techniques of anterior pelvic exenteration, and uterus/fallopian tube/ovary and nerve sparing laparoscopic female radical cystectomy are presented. Short-term functional and oncological outcomes appear favorable.

Extension of a Shortened Ureter Using the In Situ Appendix During Indiana Pouch Urinary Diversion

No AccessJournal of UrologyUrological Survey: Diagnostic Urology, Urinary Diversion and Perioperative Care1 Jun 2005Extension of a Shortened Ureter Using the In Situ Appendix During Indiana Pouch Urinary Diversion Joseph A. SmithM.D. Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)60215-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Extension of a Shortened Ureter Using the In Situ Appendix During Indiana Pouch Urinary Diversion." The Journal of Urology, 173(6), p. 2034 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 173Issue 6June 2005Page: 2034 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF DownloadLoading ...