Management of Incontinence in an Indiana Pouch: A Case Study

A 57-year-old female with a history of clear cell sarcoma of the bladder and an Indiana Pouch urinary diversion presented with stomal incontinence. Urodynamic studies identified a storage issue, leading to treatment with intra-pouch OnabotulinumtoxinA injections. The patient experienced 90-100% symptom improvement for up to 5 months. The procedure was well-tolerated, and intermittent catheterization continues to manage incontinence. This approach shows promise as an effective treatment for storage-related stomal incontinence before considering surgical revision or augmentation.