ABSTRACT
Objetivo: Valorar la función renal y los efectos colaterales de la bolsa de Indiana como método quirúrgico. Método: Reporte de serie de casos de 75 pacientes operados desde junio de 1987 hasta junio del 2008 con bolsa de Indiana. Resultados: Los tumores incluyeron 36 cánceres de vejiga, 35 cánceres de útero, 2 melanomas vaginales, 1 cáncer de vulva y 1 osteoclastoma, La bolsa se usó en 35 cistectomías radicales y 14 exenteraciones pélvicas, y en 26 pacientes se hizo sin cirugía extirpativa tumoral. El 95% de pacientes mantuvo la función renal. Los electrolitos séricos permanecieron normales. La continencia completa se consiguió en 92% de los casos. La capacidad promedio del reservorio fue de 536,5 ml; 21 (25,8%) riñones sanos se perdieron al reimplantarse. Por otra parte, 22 (56,4%) riñones hidronefróticos llegaron a ser sanos. Complicaciones: temprana, 6,66%; tardía 46,0%. Reintervención: temprana, 8,0%; tardía 40,1%. Mortalidad perioperatoria 8,0%; mortalidad acumulativa, 45,30%. Supervivencia promedio: 30,7 meses. Conclusiones: La bolsa de Indiana es una derivación urinaria útil cuando no es factible preservar la uretra. Presenta más complicaciones tardías que tempranas. La hidronefrosis, el daño parenquimatoso y la neocistolitiasis fueron frecuentes en esta serie, con 48% de pacientes irradiados.
Objective: To evaluate the renal function and side effects of the Indiana pouch at the National Cancer Institute of Colombia. Method: 75 cases with history of Indiana Pouch reconstructive surgery were recruited from June 1987 to June, 2008. Results: 36 bladder; 35 uterine cancer; 1 vulvar cancer, vaginal cancer, 2 melanomas; and 1 osteoclastoma were included. The Indiana Pouch was used in 35 radical cystectomies, and 14 pelvic exenterations. In 26 cases, there was non-surgical tumor extirpation. 95% of patients continued with proper renal function and normal serum electrolytes. Complete continence was present in 92% of cases. The average reservoir capacity was 536.5ml; 22 (24.7%) healthy kidneys were lost after re-implantation. In contrast, 22 (56.4%) hydro-nephronic kidneys became healthy. Early complications were present in 6.66% of cases; and late complications in 46.70%. Early re-intervention was observed in 8.0%; late, 40.1%. Perioperative mortality was 8.0%; cumulative mortality, 45.3%. The average survival was 30.7 months. Conclusions: The Indiana Pouch is a useful urinary device when urethra preservation is not possible. Complications occur late rather than early. Hydronephrosis, parenchymatic damage and neo-cystolytiasis were frequent in this series, wherein 48% of patients were irradiated.