Hi, Pat,
This is in regard to your request for literature on ruptures of neobladders/catherizable pouches. My info pertains to neobladders. For all I know, Indiana pouches may have a leak point that would prevent rupture. However, if any diversion is completely hypercontinent and allowed to get greatly overdistened, there is a chance for rupture. Ruptures of neobladders are rare because patient compliance keeps most from being in danger of rupture, but ruptures do happen and usually from overdistension. One of our e-mail listserv members let his neobladder get too full and unfortunately had a fall which ruptured his neobladder. Acccording to one abstract in PubMed: "Nineteen articles have been published since 1985 on spontaneous neobladder rupture..."
tinyurl.com/3yxhw6
Here is another excerpt and link from PubMed:
"The spontaneous rupture was evidently caused by overdistension of the ileal neobladder in four of five instances. In addition to overdistension, a second factor such as minor blunt abdominal trauma or urethral occlusion was identifiable in two instances. The rupture occurred in the right upper corner of the ileal bladder in four of five instances and led to acute and severe abdominal pain.
...CONCLUSIONS: The circumstances of the cases described suggest that late spontaneous rupture of an orthotopic ileal bladder replacement is not related to the surgical technique but rather to factors of patient compliance and medical management."
tinyurl.com/2jma8u
Continent urinary diversions are designed for a maximum volume of approximately 500cc. A person that never stretches his diversion to hold 400-500cc usually has incontinence problems because the unstretched pouch is a low volume, high pressure reservoir. A person that lets his neobladder CONTINUALLY(this does not apply to maybe sometimes, but not often)stretch to hold 900+cc runs the chance of developing hypercontinent problems. A properly stretched neobladder holds 400-500cc(about 2 cups) and is a high volume, low pressure reservoir. I do not understand the mechanical engineering or physics principals behind this but those that do designed these diversions.
Most guidelines for neobladders list voiding once during the sleep cycle. However, this is a quideline, not an absolute rule. The magic number is not the hours one goes between voiding, but the volume that is voided. So, if you are able to sleep for longer periods of time and are still keeping the volume around the 500cc mark, then all is well. My urosurgeon told me he wanted me to stop fluids at 7PM and to get at least 5 hours of uninterrupted sleep. However, stopping fluids in the evenings makes me very unhappy, so I prefer to drink as much as I want and to void around the 3-3.5 hour mark and then again 4 to 4.5 hours later. This works well for me, but probably would not for many others. One of the best pieces of advice my urosurgeon gave me was that I should remember that guidelines are not rules and to use common sense when applying them.
LindaW