The Kock Pouch: Initial Experience and Complications

Waters, Bedford W.
Vaughan, David J.
Harris, Richard G.
Brady, Suszette M.

From the Department of Urology, Loyola University Medical Center, Maywood and Urology Section, Hines Veterans Administration Medical Center, Hines, Illinois

^*Requests for reprints: Department of Urology, 2160 S. First Ave., Maywood, Illinois 60153.

^†Current address: 851 W. Morse Blvd., Winter Park, Florida 32781.

^‡Current address: 675 W. North Ave., Suite 301, Melrose Park, Illinois 60160.

Accepted December 22, 1986.

Read at annual meeting of American Urological Association, New York, New York, May 18-22, 1986.

Journal of Urology 137(6):p 1151-1153, June 1987. | DOI: 10.1016/S0022-5347(17)44431-4

ABSTRACT

The modified Kock continent internal reservoir procedure has been performed on 15 patients at our medical center since December 1984: 13 underwent simultaneous anterior exenteration for pelvic malignancy, 1 had conversion from an ileal conduit and 1 underwent cystectomy for refractory interstitial cystitis. There was no operative mortality. There were 3 early complications: a urinary leak from the pouch in 2 patients that required re-exploration to close the defect, and an enteric-Kock pouch fistula in 1 that required resection of the small bowel fistula and repair of the pouch defect. All 3 patients are doing well. The late complication in 3 cases was urinary incontinence of the efferent nipple valve with difficulty in catheterization of the stoma. Two patients have undergone revision with a new efferent nipple valve added on to the pouch and creation of a new stoma. One patient is completely dry and continent, 1 has tolerable intermittent leakage and refuses a further operation, and 1 is awaiting revision. Although the initial experience is small, we are encouraged by these results and believe that this procedure is an alternative form of urinary diversion for the properly selected patient.