Individuals preparing for bladder removal, usually from cancer, often need to make a crucial decision concerning how the function of removing urine from their body will be continued. Some type of reservoir must be provided to collect the urine before its discharge. Assuming there is no compelling medical reason that dictates one option over others, patients may be asked to choose whether the pouch is desired outside their body or inside.

If an internal pouch is chosen, patients then may have further choices to make, concerning the exit route for the urine. Some possibilities are through the rectum, through the penis for men, reconnect the urethra for women, or by inserting a catheter into the pouch through an opening in the abdomen called a stoma. This last arrangement is commonly known as a Florida Pouch or an Indiana Pouch.

I elected to get the Florida Pouch -in November 1996, I underwent the procedure that removed my bladder and fashioned a Florida Pouch in my lower abdomen. From a layman's perspective, I will describe what I know about it, talk about some of the problems I have experienced and tell how I care for it. Please keep in mind that I am not a qualified medical person-I am only speaking from my experience and some of the information I gathered from the Internet and my physician.

What Is It?
The Florida Pouch is a section (about 20cc) of colon that is folded and sutured into the form of a bag that becomes the urine reservoir. It is placed in the pelvic region, entirely inside the body. Both ureters are brought into the pouch, draining urine from the kidneys. A valve (stoma) is created in the abdominal wall, through which a catheter can be inserted to drain the pouch. The valve is designed to help prevent leakage. My stoma is about 3 inches to the right of and 2 inches below my navel.

Possible Problems
From my experience, an infection of the pouch can be a serious problem. Since the pouch is actually a section of colon, it continues to act as colon, manufacturing mucous. Additionally, the pouch has folds and pockets, which are difficult to clean. All in all, an excellent environment to encourage bacterial growth. I have had a couple of minor infections and one hellacious one. It came during flu season and, with the chills and fever and abdominal pains, I thought I had the flu that came, subsided and came again. The third time it flared up, I ran a fever of 102+. When that left for its brief respite, chills had me shaking uncontrollably, even under four blankets. Fortunately, my wife was a lot brighter than I and took me to the ER. After a big dose of an anti-biotic and an IV, I felt fine. To help ward off future attacks, my urologist has prescribed a continuous regimen of an anti-biotic.

Other problems come with the pouch, but I think of them more as minor annoyances. Draining the pouch in a public rest room makes you want to have a third hand. Stuffing your pocket with a zip lock bag filled with handy wipes, catheters, KY Jelly, band-aides, and gauze pads is a must when you leave home. Don't forget your medic alert necklace.

Care
The frequency of irrigating your pouch varies from daily to several times each day. This consists of using a syringe to instill a mild saline solution. I believe it depends on how new it is and how much mucous it produces. I irrigate mine daily, although if I miss a day, it doesn't bother me. I never let it go beyond that, however.

I've had my pouch for 4 ½ years. During the first couple of years, I went to my urologist semi-annually for a check-up. This involved a digital rectal exam, blood work, a CT scan, X-ray, and urine analysis. I have only recently learned that some urologists do a "pouch peek" (similar to a cysto examination). Mine has not suggested doing that although it seems to be a good idea.

Contributed by Bill Lanius

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