A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.
OBJECTIVE
To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions.


METHODS
From February 1992 to December 2000, 40 patients (mean age 55.8 years, range 21-74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed.


RESULTS
The median (range) follow-up was 47.6 (10-124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively (P = 0.13).


CONCLUSIONS
Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved.
Soulié
M
M
Department of Urologic Surgery and Andrology, Rangueil University Hospital, Institut Cludius Regaud, Toulouse, France. soulie.m@chu-toulouse.fr
Seguin
P
P
Martel
P
P
Vazzoler
N
N
Mouly
P
P
Plante
P
P
D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000209:etiology*; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods; D014549:Urinary Incontinence / Q000209:etiology; D016476:Urinary Reservoirs, Continent; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*