A patient at the end of life is no longer able to self catheterize with a continent urinary diversion (i.e., Indiana Pouch Reservoir). No reliable caregivers are available. Can the catheter be left in to drain into a urostomy pouch? Should it be secured with or without a balloon? — Anne Walsh, APRN-BC, Long Beach, N.Y.

While the Indiana pouch may drain spontaneously, it does not empty completely and requires intermittent straight catheterization. Indwelling catheters are not recommended because a very small catheter is used, and the mucous production often quickly occludes the tube, causing urine to back up to the kidneys.

The patient described here may need to visit a urologist for an alternative urine-drainage system, such as an ileal conduit, which drains continuously and does not store the urine. This may not be as complicated as it seems since the Indiana pouch also uses a piece of the ileum. The pouch or neobladder lies between the ureters and the conduit. A simple ileal conduit may allow the pouch to be removed. — Marie Mangino, MSN, GNP-BC, Vincent Healthcare, Inc., Clinical and Educational Specialists, Erdenheim, Pa. (162-3)