Modification of the Kock's pouch for bladder replacement.
OBJECTIVE
To describe a modification of the Kock's pouch and present our clinical experience in its application.


METHODS
After isolating an adequate ileal segment, the bowel is split by a longitudinal incision, with both ends remaining unopened for about 3-4 cm in length. Previously anastomozed ureters are inserted into the proximal end so that a nipple valve is created. The distal unsplit end serves for a direct anastomosis with the urethra. During the past 9 years, this surgery was performed in 41 patients who underwent radical cystectomy due to invasive carcinoma. Seventeen patients died for unknown reasons or were lost to follow-up. The remaining 24 were included in the follow-up for a period of 7 months to 6 years post surgery.


RESULTS
Half of the patients included in the follow-up urinated spontaneously, with post void residuals less than 120 mL and no need for catheterization. Four patients did not urinate spontaneously and needed continuos catheterization, whereas 8 patients had post void residuals of 150-200 mL and needed catheterization once a day or once a week. None of the patients had a stricture at the site of ureteroileal anastomosis.


CONCLUSIONS
We believe that our modification of the Kock's pouch makes the uretero-intestinal anastomosis much easier to perform; both ureters are inserted into the unsplit bowel end, thus preventing reflux; anastomosis with the urethra is performed under visual control; and direct anastomosis of widely opened distal end of the bowel reduces the possibility of scar stenosis.
Tucak
A
A
Department of Urology, Osijek University Hospital and School of Medicine, J. Huttlera 4, 31000 Osijek, Croatia. kbos-urologija@kb-osijek.tel.hr.
Novak
R
R
D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D015653:Cystectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012086:Reoperation; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*