Indiana augmentation cystoplasty (IAC) is a popular form of continent catheterizable diversion where the terminal ileum forms a catheterizable channel, and a buttressed ileocecal valve is used as the continence mechanism. The ascending colon is detubularized and sutured to the opened bladder, creating low pressure urinary reservoir.1 Elimination of urinary drainage bags, increased independence, and improved body image have been cited by up to 80% of patients undergoing continent urinary tract reconstruction as factors improving quality of life. 2 Limited literature exists on standards of management of efferent channel catheterization complications. Difficulty catheterizing may represent stenosis or stricture of the efferent limb, or the creation of a false passage during repeated catheterizations. Initial evaluation should include endoscopy to investigate the channel and pouch, in particular the efferent limb, which tends to elongate and stretch over time. Revision requires mobilization and shortening of the channel via an open approach. Care must be taken to preserve channel functionality. Principles of open revision generally employ the simplest technique possible, while avoiding creating new complications such as bowel obstruction and fistula. Typically, the efferent limb is mobilized and the revision efforts are localized to the region of the pouch to avoid the rest of the abdominal cavity unless necessary.3 In this case report, we present a patient with difficulty catheterizing the efferent limb of her IAC after significant weight loss.
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