The Kock pouch is created by sewing together pieces of small intestine and then creating a nipple valve at the lower right side of the abdomen. The Indiana pouch is created using parts of both the small intestine and large intestine and then pleating a section of small intestine to form the valve. Creation of either the Indiana and Kock pouch requires you to insert a catheter through the valve to empty the pouch several times each day. The location of this stoma can be very low, just above the pubic hairline, as long as it is easily visible for intubation, and it is a location that would allow use of a pouching system if necessary.
The stoma will begin to function immediately, but the urine may be blood tinged for a few days. It is normal for shreds of mucus to be visible in the urine because it is flowing through a segment of intestine. You will have stents in your ureters to keep them open because of post-operative swelling and a drainage tube through your stoma. You may also have a cecostomy tube directly into the pouch to help keep the pouch drained as it heals. Your doctor will give you specific instructions about irrigating these tubes every few hours for the first weeks after surgery. After a successful pouch-o-gram, you will be taught how to “intubate” the pouch to drain the urine. You will need to insert a catheter into the stoma every 2 to 3 hours at first, but gradually the capacity of the reservoir will increase and you will have to intubate every 4 hours. You should empty right before bedtime and as soon as you awaken, or you might need to empty once during the night. It’s also important to wear identification to alert emergency personnel that you have a continent urinary reservoir.
There aren’t any restrictions on your diet, but be sure to drink 8 to 10 glasses of fluid each day.
Durable wafer, drainable urostomy pouch, night-time drainage. After a successful pouch-o-gram, no pouching system will be needed.