title: Revision of nonfunctioning kock pouch efferent limb: continent, tissue preserving technique.
abstract: OBJECTIVE
  Despite extensive surgical experience with the intussuscepted efferent nipple of the Kock pouch, complications are not unusual. Although most repairs are relatively simple, the use of intestinal segments is necessary for reconstruction of the complete efferent limb in cases of severe stenosis, pre-stenotic diverticular enlargement or partial necrosis. We describe the tissue preserving transformation of an inadequate efferent Kock pouch outlet into a flap-valve continence mechanism.
  
  
  METHODS
  In 5 women a new efferent limb for the Kock pouch was created by transverse retubularization of the short intact ileal segment of the original limb. Continence was preserved through the construction of a Mitrofanoff-like flap valve, created by embedding the new ileal tube in an extramural trough.
  
  
  RESULTS
  At followup ranging from 6 to 28 months all patients were continent and experienced no problems with catheterization.
  
  
  CONCLUSIONS
  This technique of transverse retubularization of the inadequate efferent ileal limb and creation of a flap valve has obvious advantages. No new small bowel segments are required, thereby simplifying and shortening the procedure. The newly created ileal tube is wide (16 to 18Fr) and easy to catheterize. The mucosal folds are longitudinal and do not impede catheterization. The remaining thin layer of mesentery is set in the center of the tube and permits construction of a straight extramural tunnel.
authors.affiliation: Department of Adult and Pediatric Urology, University of Witten-Herdecke Medical School, Klinikum Barmen, Wuppertal and Department of Urology, University of Münster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Waldner
authors.forename: L
authors.initials: L
authors.lastname: Hertle
authors.forename: S
authors.initials: S
authors.lastname: Roth
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D019651:Plastic Surgery Procedures; D012086:Reoperation; D016476:Urinary Reservoirs, Continent