title: Complications of the afferent antireflux valve mechanism in the Kock ileal reservoir.
abstract: OBJECTIVE
  Since 1982 the Kock ileal reservoir has been the primary form of urinary diversion in patients requiring lower urinary tract reconstruction at our institution. The intussuscepted afferent nipple valve of the Kock ileal reservoir is designed to prevent reflux and protect the upper urinary tract. Problems associated specifically with the afferent antireflux valve have been few. We defined and characterized all complications associated with the Kock pouch antireflux nipple valve.
  
  
  METHODS
  From November 1984 through July 1992, 802 patients underwent construction of a continent Kock ileal reservoir. All complications associated with the afferent antireflux valve in this group and their management were identified.
  
  
  RESULTS
  Overall, 79 of 802 patients (9.8%) had a total of 84 complications of the afferent antireflux valve (10.4%), including formation of stones on staples securing the afferent nipple valve in 42 cases (5.2%), stenosis of the afferent valve in 35 (4.3%) and prolapse of the valve in 7 (0.9%). A total of 81 patients required surgical intervention to correct the afferent valve complication: 56 (7.0%) were treated endoscopically and 25 (3.1%) required open surgical revision.
  
  
  CONCLUSIONS
  We report an overall complication rate of 10.4% associated with the afferent antireflux nipple valve in the Kock ileal reservoir. Most complications can be treated endoscopically without difficulty on an outpatient basis with the use of local sedation. With these results, and only a 3% incidence of open surgical correction of all afferent nipple problems, we encourage the continued use of the intussuscepted afferent nipple valve whenever continent urinary diversion is performed.
authors.affiliation: Department of Urology, University of Southern California Medical Center, Los Angeles, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Stein
authors.forename: J A
authors.initials: JA
authors.lastname: Freeman
authors.forename: D
authors.initials: D
authors.lastname: Esrig
authors.forename: D A
authors.initials: DA
authors.lastname: Elmajian
authors.forename: T H
authors.initials: TH
authors.lastname: Tarter
authors.forename: E C
authors.initials: EC
authors.lastname: Skinner
authors.forename: S D
authors.initials: SD
authors.lastname: Boyd
authors.forename: J L
authors.initials: JL
authors.lastname: Huffman
authors.forename: G
authors.initials: G
authors.lastname: Lieskovsky
authors.forename: D G
authors.initials: DG
authors.lastname: Skinner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D001744:Urinary Bladder Calculi / Q000209:etiology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects* / Q000379:methods*