Indiana pouch  An Indiana pouch is a surgically-created urinary diversion used to create a way for the body to store and eliminate urine for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrophy or who are not continent due to a congenital, neurogenic bladder. This particular urinary diversion results in a "continent" reservoir that the patient must catheterize to empty urine. This concept and technique was developed by Drs. Mike Mitchell, Randall Rowland, and Richard Bihrle at Indiana University. With this type of surgery, a reservoir, or pouch, is created out of approximately two feet of the ascending colon and a portion of the ileum (a part of the small intestine). The ureters are surgically removed from the bladder and repositioned to drain into this new pouch. The end of the segment of small intestine is brought out through a small opening in the abdominal wall called a stoma. Since a segment including the large and small intestines is utilized, also included in this new system is the ileocecal valve. This is a one-way valve located between the small and large intestines. This valve normally prevents the passage of bacteria and digested matter from re-entering the small intestine. Originally, it was thought that removing the ileocecal valve from the digestive tract would likely result in diarrhea, but this has not shown to be the case. After a period of several weeks, the body adjusts to the absence of this valve (from the digestive tract) by absorbing more liquids and nutrients. Importantly, this valve, in its new capacity, will now effectively prevent the escape of urine from the stoma. The passage of the conduit through the abdominal wall allows the rectus abdominis muscle to aid with continence. The surgery itself along with recovery time depends on the patient. Robotic surgery can take approximately 6-12 hours. A patient's time in the hospital can take 7–10 days if no complications present themselves. Depending on the type of surgery the abdominal incision for this surgery may be up to eight inches in length and is typically closed with staples on the outside and several layers of dissolvable stitches on the inside. After surgery, patients will have three drainage tubes place while tissues heal: one through the newly created stoma, one through another temporary opening in the abdominal wall into the pouch, and an SP tube (to drain non-specific post-surgical abdominal fluid).