The urethral Kock pouch: long‐term functional and oncological results in men

• Published in: BJU international 2003-09, Vol.92 (4), p.429-435
• Main Authors: Shaaban, A.A., Mosbah, A., El‐Bahnasawy, M.S., Madbouly, K., Ghoneim, M.A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; bladder; Disease-Free Survival; Female; Follow-Up Studies; Humans; Kock pouch; Male; Medical sciences; Middle Aged; Radiography; Second-Look Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urethral Stricture - etiology; Urinary Bladder Neoplasms - diagnostic imaging; Urinary Bladder Neoplasms - physiopathology; Urinary Bladder Neoplasms - surgery; Urinary Calculi - etiology; urinary diversion; Urinary Diversion - adverse effects; Urinary Diversion - methods; Urinary Reservoirs, Continent - adverse effects; Urinary Reservoirs, Continent - physiology; Urodynamics - physiology
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-410X.2003.04346.x

The Department of Urology in Mansoura has a well‐known experience in, among many things, urinary tract reconstruction in patients with bladder cancer. They review their results in 338 male patients who had a radical cystectomy and Kock pouch. They found good functional and oncological outcomes in properly selected patients. However, they also drew attention to several valve‐related complications. OBJECTIVE To evaluate our experience with men who underwent radical cystectomy and urethral Kock pouch construction between January 1986 and January 1996. PATIENTS AND METHODS Complications were classified as early (within the first 3 months after surgery) or late. Continence was assessed by interviewing the patient; they were considered continent if they were completely dry with no need of protection by pads, condom catheter or medication. The patients were followed oncologically and Kaplan‐Meier survival curves constructed. Urodynamic studies were used to define the possible causes of enuresis. RESULTS Three patients died after surgery from pulmonary embolism. There were 67 early complications in 63 patients. The mean (sd) follow‐up was 87.8 (49.1) months. There were 111 treatment failures from cancer; of these, four men only had an isolated local recurrence in the urethra. Late complications included 72 pouch stones in 55 patients, and 36 deteriorated renal units caused by reflux (17), uretero‐ileal stricture (11), nipple valve eversion (four) or stenosis (four). Interestingly, 65 renal units that were dilated before surgery improved significantly afterward. Ileo‐urethral strictures occurred in seven men and anterior urethral strictures in six. Nine patients were totally incontinent and two had chronic urinary retention. Daytime continence was complete in 94% of men, with nocturnal enuresis in 55; the latter had significantly more residual urine, and a higher amplitude and duration of phasic contractions. CONCLUSIONS Orthotopic bladder substitution after cystectomy for cancer is feasible, with good functional and oncological outcomes in properly selected patients. Nevertheless, the use of a hemi‐Kock pouch is associated with many valve‐related complications.