A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results

• Published in: BJU international Vol. 90; no. 4; pp. 397 - 402
• Main Authors: Soulié, M., Seguin, P., Martel, P., Vazzoler, N., Mouly, P., Plante, P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.09.2002; Blackwell
• Subjects: Adult; Aged; Biological and medical sciences; continent urinary diversion; cystectomy; Cystectomy - methods; Female; Humans; ileum reservoir; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Nephrology. Urinary tract diseases; Postoperative Complications - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tumors of the urinary system; Ureter - surgery; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; urinary continence system; Urinary Diversion - adverse effects; Urinary Diversion - methods; Urinary Incontinence - etiology; Urinary Reservoirs, Continent; Urinary tract. Prostate gland; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Human; Urinary system disease; Treatment efficiency; Intussusception; Anatomical reconstruction; Urinary tract disease; Malignant tumor; Ileum; Urinary incontinence; Voiding dysfunction; Cystectomy; Extracorporeal bypass; Urinary bladder; Surgery; Cohort study; Complication; Bladder disease; Technique
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-410X.2002.02909.x

Objective  To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. Patients and 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). Conclusion  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.