Radical cystectomy is currently the standard treatment for muscle-invasive bladder tumors, but it is also performed in certain cases of functional and reconstructive surgery, such as radiation-induced cystitis with urethral involvement (sphincter insufficiency, stenosis, fistula, symphysitis).

Urinary diversion is most often performed as either a non-continent urinary diversion, such as the Bricker procedure, or a continent urinary diversion, such as a neobladder. 
The heterotopic continent urinary diversion technique of the Miami/Indiana type, utilizing an ileocolic reservoir with the terminal ileal loop as a continent cystostomy, is a less commonly used technique but may meet the expectations of certain patients in terms of quality of life.

The objective of this study was to report the outcomes of patients who underwent radical cystectomy with heterotopic continent urinary diversion using an ileocolic reservoir of the Miami/Indiana type.

All patients who underwent cystectomy with heterotopic continent urinary diversion using an ileocolic reservoir of the Miami/Indiana type between April 2021 and February 2024 at a university center were included in a retrospective study. 

All procedures were performed via laparotomy. This type of diversion was proposed as an alternative to the ileal neobladder in patients requiring radical cystectomy for bladder cancer as well as in patients with radiation-induced cystitis and urethral involvement.

The primary endpoint was the improvement in quality of life, assessed by a PGII score ≤2. Secondary endpoints included stomal continence, postoperative complications, and the number of catheterizations per 24 hours.

Twelve patients were included in this study (7 women and 5 men). The mean age was 58 years (range: 37–77). The indications for surgery were bladder cancer in 4 patients, radiation-induced cystitis with fistula or symphysitis in 7 patients, and 1 patient with a Coffey-type condition complicated by multiple lithiasis. All patients refused non-continent cutaneous urinary diversion of the Bricker type.

The main patient characteristics are described in Table 1.

The rate of major complications was 41%.

Two (16%) radiation-induced cystitis patients developed spontaneous fistulization of the reservoir to the skin several months postoperatively, requiring bilateral nephrostomy placement, which allowed fistula closure in one case.

One patient (8%) was unable to perform self-catheterization despite a patent and continent conduit, leading to conversion to a Bricker diversion.

At 3 months, 9 patients (75%) met the primary endpoint with a PGII score ≤2.

At the last follow-up, 10 out of 12 patients (83.3%) were using their reservoir and continent cystostomy. 
Among these patients, stomal continence was achieved in 90%, with one patient requiring a Deflux injection that partially improved continence. A cutaneous stenosis requiring stomal revision occurred in 10% of cases.

At 3 months, patients performed an average of 6 self-catheterizations per day, which decreased to 5 per day at 1 year. The mean catheterization volume was 300 mL at 3 months and 400 mL at 1 year.

Cystectomy with Miami/Indiana-type urinary reconstruction can be considered as a last resort in patients unwilling to alter their body image or those ineligible for orthotopic continent diversion. 

Despite occasional severe acute complications, this type of surgery provides good functional outcomes, particularly in terms of stomal continence, thanks to the natural anti-reflux mechanism of the ileocaecal valve.