Robotic Indiana pouch fundoplication for management of post-Indiana pouch urinary leakage

Kathryn Fink, Jonathan Rosenfeld, Shivani Kumaresan, Olivia Ben-Levy, Anna Lytchakov, Shania Wang, Diboro Kanabolo, Ziho Lee^*
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
* Corresponding Author: Ziho Lee. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.084280

Received 20 April 2026; Accepted 31 July 2026; Published online 26 August 2026

Abstract

The Indiana pouch is a continent catheterizable urinary diversion that can provide durable continence. Although rare, persistent leakage from the catheterizable channel is a difficult complication to manage. We describe our technique for robotic fundoplication of the Indiana pouch in a patient with refractory stoma incontinence despite preserved pouch compliance and capacity. A 37-year-old woman with neurogenic bladder had continuous leakage from her catheterizable channel for nine years after cystectomy and Indiana pouch creation. Preoperative evaluation showed a compliant 600 cc reservoir without elevated storage pressures, suggesting failure of the channel continence mechanism rather than reservoir dysfunction. During robotic revision, indocyanine green was instilled into the pouch, and near-infrared fluorescence imaging was used to facilitate adhesiolysis and identify pouch boundaries. The colonic segment of the pouch was then wrapped around the catheterizable channel using interrupted sutures in a fundoplication-style fashion to augment outlet resistance while preserving catheterizability. The patient had immediate resolution of leakage and remained continent without obstruction at one-year follow-up. The objective of this report is to describe the operative steps, technical considerations, and early outcome of a robotic fundoplication approach for refractory Indiana pouch channel incontinence.