Orthotopic continent urinary reservoir (Indiana Pouch) in children after cystectomy for bladder exstrophy

In cases of failed exstrophic closure, total cystectomy is sometimes performed combined with external urinary diversion or ureterosigmoidostomy. Prolonged life expectation and the request for a high quality of life, characteristic of pediatric and juvenile age, make it mandatory to look for different surgical solutions.Among 44 patients (26 males and 18 females) born with “exstrophy-epispadias complex”, the creation of a new orthotopic urinary reservoir, according to the “Indiana Pouch” technique, was chosen in 2 children, 4 and 9 years of age respectively, who had previously undergone a total cystectomy elsewhere. The reservoir is made of a ceco-colic segment 35 cm long detubularized on one tenia and remodelled. Ureters are reimplanted with an antireflux technique on the second tenia. Continence is assured by the ileo-cecal valve opportunely reinforced.Both patients are now perfectly continent day and night and voiding is assured by transurethral intermittent catheterization.