Kock urinary reservoir maturation in children and adolescents: consequences for kidney and upper urinary tract.
OBJECTIVE
To study Kock reservoir maturation in children and adolescents and its effects on the kidneys and upper urinary tract.


METHODS
Ten boys and 10 girls, aged 10.8-18 years, had Kock reservoir surgery for congenital urinary incontinence. They were followed for 3-10 years, divided into 3 different periods, and assessed with urography and enterocystography, the findings of which were correlated to renal function as measured by (51)Cr EDTA clearance, reservoir endoscopy and patient's history.


RESULTS
The reservoir was located in the pelvis and remained in this position throughout the whole follow-up in 75% of patients and in the lower or midabdomen in 25%. Angled efferent nipple seen on enterocystoscopy or enterocystography coincided with nipple dysfunction, reservoir malposition or infrequent reservoir emptying. Upper urinary tract dilatation was detected in 84% of patients 3 months after surgery, 25% at 1 year and 30% at 2-10 years. The dilatation was improved in 56% of patients and unchanged in 25% after 1 year. The situation continued to improve at late follow-up. New focal renal scars were radiologically detected in 1 of 19 at early and in another 1 of 17 patients at late follow-up. Progression of old scars was detected in 1 of 19 at early and in 4 of 17 at late follow-up. Eight of 19 cases had deterioration of renal function with a change in the split renal function. Of these 8 patients, 7 reported infrequent reservoir evacuation.


CONCLUSIONS
Kock reservoir is a useful form of urinary diversion in children and adolescents with congenital urinary incontinence. Radiological examinations are good methods of follow-up of the maturation of the pouch and its effects on the urinary tract and for detection of complications. Urinary tract dilatation is a frequent finding early after surgery but it subsides in most cases 3-12 months after surgery. Long-term efferent nipple dysfunction may be the result of angulation, reservoir stones, malposition and/or overdistension. Permanent renal damage may be due to pyelonephritis, stones, infrequent reservoir emptying or urinary obstruction. A strict regime of reservoir evacuation to avoid overdistension and nipple dysfunction and to decrease the possibility of renal function deterioration is strongly advisable in these patients. It is imperative that their own management of the reservoir is continuously supervised.
Abd-el-Gawad
G
G
Department of Paediatric Surgery, Sahlgrenska University Hospital/Ostra, Göteborg University, Göteborg, Sweden. Gamal.Abd-el-Gawad@sahlgrenska.se
Abrahamsson
K
K
Hanson
E
E
Norlén
L
L
Sillén
U
U
Stokland
E
E
Hjälmås
K
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D014549:Urinary Incontinence / Q000151:congenital* / Q000601:surgery*; D014551:Urinary Tract / Q000503:physiopathology; D014567:Urography