[Urinary diversion with Kock pouch: clinical results in 75 cases focusing on late complications].
Internal urinary reservoir type urinary diversions have been getting popularity since Kock reported a continent ileal reservoir in 1982. From November 1984 through October 1987, we performed Kock pouch operation in 75 patients (male 64, female 11; from 24 to 82 years old, mean age 56 years old). The underlined diseases were mostly bladder cancer patients; bladder cancer 70, rectal cancer 2, prostatic sarcoma 1, vesical exstrophy 1 and neurogenic bladder 1 case. The end results for 71 evaluable cases, followed up more than 3 months, were excellent in 49 (69%), good 14 (20%), fair 6 (8.5%) and poor 2 (2.8%), with success rate 89%. The most common complication was the nipple malfunction; prolapse, including intermittent prolapse, in 7 patients, slippage or sliding in 1, and eversion in one patient. Stone formation occurred in 6 patients, mild acidosis in 2 and a entero-pouch fistula in a patient who was re-diverted from a ileal conduit. There were 2 deaths postoperatively. Late complications were prominently decreased due to several important modifications of the operative technique, such as usage of Cavitron Ultrasonic Surgical Aspirator (CUSA) for defatting the mesentery, and fixing the nipple to the pouch. In conclusion, Kock pouch can be a safe and sound operative modality for patients who need urinary bladder replacement.
Okada
Y
Y
Department of Urology, Faculty of Medicine, Kyoto University.
Arai
Y
Y
Oishi
K
K
Takeuchi
H
H
Yoshida
O
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011471:Prostatic Neoplasms / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*