Renal Function and Upper Urinary Tract Configuration Following Urinary Diversion to a Continent Ileal Reservoir (Kock Pouch): A Prospective 5 To 11-Year Followup after Reservoir Construction

Abstract

We followed 17 patients who underwent urinary diversion via a continent ileal reservoir (Kock pouch) with yearly examinations for 5 to 11 years postoperatively. The examinations involved control of renal function and configuration of the upper urinary tract. In 5 patients the upper urinary tract had become dilated during followup and in 2 of these renal scarring also had developed. All 5 patients had endured temporary outflow obstruction or reflux (stricture, overdistension of the reservoir or a defective antireflux valve). Of the patients 1 had a marked decrease in renal function before the outflow obstruction was corrected by an operation. Routine blood chemistry study was normal and hyperchloremic acidosis was not noted in any patient. After peroral loading of 6 patients with ammonium chloride significant excretion of titratable acid was found in the urine. Substitution with vitamin B12 was given to 6 patients due to subnormal values in 2 and borderline values in 4.

Complications of the Mainz Pouch II (Sigma Rectum Pouch)

“…It has been suggested that the complication rate of any new technique of urinary diversion should be compared to that of the gold standard Bricker ileal conduit [8, 35, 36]. Although the ileal conduit has stood the test of time for 5 decades, many series have verified significant renal and metabolic complications in the long run [37, 38, 39, 40].…”

Modified Ghoneim’s Technique Using a Single Serous–Lined Extramural Tunnel in Detubularized Orthotopic Ileal W–Bladder

“…Several surgical techniques are currently employed to prevent reflux [1, 2, 3, 4, 5], but to date it is unknown whether antireflux ureteral implantation in a low pressure reservoir is necessary because no coordinated contraction of the neobladder can cause an isolated intravescical pressure increase and possible reflux during micturition [7]. Nevertheless we agree with the urologists who assert that effective antireflux ureteral implantation is preferable because it may prevent hydronephrosis and pyelonephritis in females who could develop hypercontinence [8]or in males with a long life expectancy who could present severe voiding dysfunctions related to stenosis of the uretho–intestinal anastomosis.…”

Kock Urinary Reservoir Maturation in Children and Adolescents: Consequences for Kidney and Upper Urinary Tract

“…The most important demand for any bladder substitute is that it should not endanger the integrity of the upper urinary tract [2]. The Kock reservoir fulfils these essential criteria of a highly compliant internal reservoir in that it is truly continent, easy to catheterize and prevents reflux to the kidneys [3].…”